Please
Join Today!
Please print the form below and mail it with your check (payable to
FRIA) to:
18 John St. Suite 905, New York, NY 10038
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FRIA's strength comes from relatives, nursing home residents and others
who share our vision of affordable, high-quality, long-term health
care for all New Yorkers. It is because of the support we receive
through membership dues that we can continue to keep this vision strong.
Annual
Membership Donation
Includes
our FRIA Newsletter, and notification of events and activities
Membership is not open to nursing homes, adult homes, or other long-term
care residential providers or their staff.
____________________________________________________
Individuals: $35: ___
Professionals: $45: ___
Organization: $100: ___
Added Contribution to help FRIA:
$50: ___ $150: ___ $250: ___ $500: ___ Other: _____
Name: ______________________________________________
Company or Organization: ___________________________
Address: ___________________________________________
City, State, Zip: __________________________________
Telephone (H) _________________ (W) ________________
E-Mail Address: ____________________________________
If you regularly visit a nursing home resident,
please share with us which home: ___________________
If you are a nursing home resident or regularly visit
someone who is, we want you as a member even if you
can't afford dues. Send us the information and we will
determine your dues on a sliding scale.
____________________________________________________
Check
box if you do not wish your personal information to be shared outside
the organization.
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