Renewal Authorization Form

2021-2022 Fiscal Year Membership Renewal Agreement


The Arizona Council announced in June 2021 that starting this year, Council Membership Renewals will be automatic, with no need to complete a new application form. Our rates have not changed, and we will keep each member on the payment plan that you have previously agreed to. Your invoice indicates what type of payment cycle you are currently on. For example, you can make payments monthly, quarterly, or annually. 

Any member agency can cancel their membership at any time and your dues will be pro-rated. A fee schedule is attached for your reference. 

If you need to make changes to your organization’s payment schedule, or cancel your membership, please contact Shannon Higgins for assistance at shiggins@azcouncil.com.

By signing below, you acknowledge that you are authorized to enter into contracts on behalf of your organization and commit to the AZ Council membership renewal process, with a fiscal year of July 1 – June 30. In consideration of your dues payment the Arizona Council agrees to recognize your organization as a member and grant your organization with all privileges of membership.  

 Approval from Arizona Council of Human Service Providers

FY 2021-2022 DUES

Dues are calculated based on revenues for your organization’s most recently completed fiscal year.  Pass through dollars and revenues for services other than behavioral health, child welfare, juvenile justice, and housing should not be included in the final calculation.  Please check the appropriate dues level for your organization.