Georgia Supportive Housing Association
2010 Membership Application
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Name of Organization:
Name of contact person:
Title:
Address:
Phone
Fax
Email
Web Site
We/I qualify to become a member of GSHA as checked
below:
Regular Member:
Housing organization as described below (check all that apply):
□ A significant part of our purpose or mission is to produce
or manage supportive housing.
□ We provide social services in connection with one or more
supportive housing projects.
□ We have current
audited financial statements or current financial statements reviewed by a
CPA.
□ We are actively engaged in implementing a plan to develop
supportive housing.
2010 Dues for Full Members
(check one):
□ 2009 operating with 10
or more employees
Dues
$100
□ 2009 operating with
fewer than ten employees
Dues
$100
Sustaining Member: An organization that is not directly engaged
in the development of supportive
housing or the provision of services connected
to affordable housing but seeks to
promote the purposes of the organization.
2010 Dues for Sustaining Members—Any
organization that wants “feet in the hall”
or wants special attention for a particular advocacy issue Dues
$2000
Affiliate Member (check one):
□ We are a
community-based nonprofit organization that supports the mission of GSHA but do
not
qualify as a Full Member.
□
We are a company, agency, intermediary, or
organization that supports the mission of GSHA
and does not qualify as a Full Member
or I am an individual that supports the mission.
2010 Dues for Affiliate Members
(check
one):
□ An
individual Dues $100.00
□ Any
entity that provides services or financing to supportive housing projects
Dues $500.00
Our/my
dues of $_________________ are enclosed.
( Dues may be paid quarterly)
Please make
payable to “GSHA” and mail to: GSHA,
660 Woodland Avenue,
Atlanta,
GA
30316.
Signed
Date
_______________________________________________________________
Office Use Only: Received ______________ Approved ____________
Notified____________
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