SCAIPC Membership and Resource Directory Form 2014
  1. Please enter the information below and click the submit button
  2. Application Type
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  3. Date
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  4. Representative(*)
    Please type your full name.
  5. Business / Organization
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  6. Phone(*)
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  7. Address(*)
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  8. Address line 2
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  9. City(*)
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  10. State(*)
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  11. Zip(*)
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  12. Website
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  13. E-mail(*)
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  14. Resource Description
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    5 word description of aging in place resources offered.
  15. Comments
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  16. Please select at least one Committee
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  17. Include in SCAIPC Resource Directory?(*)
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  18. Resource Directory Listing Fees are as follows:
    $125 annual: Jan 1 – Dec 31
    $65 semi annual: July 1 – Dec 31
    $25 – non-profit
  19. Payment Options


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  20. Mail check to: SCAIPC, 147 Wappoo Creek Drive, Suite 105 Charleston, SC 29412
  21. Payment
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  22. Total
    0.00 USD
  23. Check Number
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    (If available, else leave blank)
  24. Check Amount
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  25. Please upload your company logo using this form or email your logo to: membership@scaipc.org
  26. Upload Logo
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  27. SCAIPC Code of Ethics(*)
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  28. Anti Spam
    Anti Spam
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    Please re-type these letters:
  29.