LeadingAge CAST Patron Application

As a Program of LeadingAge, CAST provides its basic benefits for free to ALL LeadingAge Provider Members, who can take advantage of these benefits by logging into My.LeadingAge.org and selecting “Technology Initiatives” as an interest area.

Company Name

Address

City

States

Zip

Website

Primary Contact

First Name

Last Name

Phone

Email Address

Secondary Contact

First Name

Last Name

Phone

Email Address

Description of company and technology related interests

Buyer's Guide Lising

Our organization and/or subsidiaries sell products and services to other LeadingAge provider members, and we’d like to be listed in the LeadingAge Buyers Guide (a CAST Patron Benefit.)

Organization Category

LeadingAge Provider Member $10,000 IAHSA Provider Member $10,000 For Profit Providers $15,000

Payment Information

Name on Card

Card Number

MM

YY

Security Code

Billing Email

*Applications for 2023 will be accepted until September 30, 2023. After September 30, it will be processed for 2024 membership.

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