2025 Associate Membership Renewal Form

Thank you for your commitment to the human services sector in Massachusetts. As we enter our 50th year - we reflect on our achievements together. We hope that you will be part of the next 50 years and encourage you to renew your Providers' Council Associate membership TODAY for January 2025 thru December 2025.

Associate Member Organization

Any changes to address and/or phone number since last renewal?

Yes

Please Note any CHANGES in address/location and/or Preferred Phone Number

Address

Suite/Building #

City

State

Zip Code

Preferred Phone Number

Primary Contact Details

First Name

Last Name

Job Title

Would you like to add additional contacts to this membership account?

Yes

Additional Contact(s)

Please let us know if anyone else at your organization would benefit from information about our marketing opportunities or human service sector news.
To add more than one person, click 'Add another response' below.

First Name

Last Name

Job Title

Email Address

Membership Benefits

Would you like a link to your website posted on Providers' Council's website? (www.providers.org)

Yes

If yes, please share updated URL link below.

Would you be interested in presenting a webinar/workshop for our members in 2025?

Yes

If yes, please share area of interest.

Are you looking to advertise (the Provider newspaper, e-newsletters) in 2025?

Yes

If yes, what month would be best to reach out.

Would you be willing to share the Councils' digital badge on your website?

Yes

Do you receive Delta Dental insurance through the Providers' Council?

Yes

Would you be willing to share an image, video or story about you or your organization's impact on the human services sector within the last 50 years?

Yes

ASSOCIATE MEMBERSHIP DUES $600

Note: Dues are not deductible as a charitable contribution.

Associate Membership Dues: $

Foundation Membership Dues: $

Foundation Membership Dues include access to Delta Dental rates through the Council.

Payment Method

Make checks payable to Providers' Council/MCHSP.

ACH Transfer

Total Amount Due (includes a 3.5% convenience processing fee)

We are grateful for your Associate membership to the Providers' Council and

look forward to working with you in 2025!

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Contact Information