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Home
About Us
About the Council
About the Foundation
About PAC
Who We Are
Council Team
Board of Directors
Become A Member
Membership Benefits
Types of Membership
Committees
Accomplishments
List of Current Members
Member Application
Member Contract
Renewal Authorization Form
Email Distribution List
Foundation
Programs and Resources
Programs and Resources
Neurosequential Model in Caregiving
Careers
Events
Contact Us
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Renewal Authorization Form
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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.
Name of Member Organization *
Title of Authorized Signatory *
Signature *
Date *
Approval from Arizona Council of Human Service Providers
Signature of President & CEO, Candy Espino *
Date *
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.
Associate/Vendor Membership
$2,500
Direct Service Providers/Dues Amount Annually
Select all that apply
$750
$1,500
$2,432
$3,674
Health Plans/Managed Care Organizations
$18,500
Annual Agency Revenue Range
Select all that apply
$0 - $499,999
$500,000 - $999,999
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