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2015 Membership Application Georgia Association for Supportive Housing
Name of Organization: Name of contact person: _____________________________Title:__________________________
Second contact: _____________________________Title:__________________________
Address:______________________________________________
______________________________________________________
Phone___________________________ Fax
____________________________
Email
_________________________ Web
Site____________________________________
2nd
Email__________________________________________
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 are actively engaged in implementing a plan to develop
supportive housing.
2015 Dues for Full Members: $150
Sustaining Member: An organization that has the production of
supportive housing as a high priority and seeks to make a special impact on the
policies and programs of the State of
2015 Dues for Sustaining Members:
$500 or wants special attention for a particular advocacy issue within the scope of GSHA.
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.
2015 Dues for Affiliate Members (check one):
□ An individual: $75.00
□ An
organization: $150.00
□ Any entity that
provides services or financing to supportive housing projects: $500.00
Our/my
dues of $_________________ are enclosed.
( Dues may be paid quarterly) Please make
payable to “GSHA” and mail to: GSHA,
Signed ___________________________________ Date___________Office_________________
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