I, HEREBY APPLY, on behalf of the hereinafter named nursing home, for membership in Innovative Health Alliance. (The Applicant, if accepted, will conform to the Codes of Ethics, Constitutions and Bylaws of this Association.)
The information supplied hereinafter is accurate to the best of my knowledge and belief. I hereby authorize Innovative Health Alliance to make such inquiries as it may desire to verify the qualifications of the nursing home for membership therein.
I HEREBY AGREE TO SUBMIT MY CHECK WITHIN TEN (10) DAYS OF APPLICATION APPROVAL AND MONTHLY THERE AFTER, IN PAYMENT DUES. Annual Dues are calculated at $68.00 per bed for each facility
If you have questions, please call our office at 601-325-3298 or e-mail your questions to firstname.lastname@example.org