2010 New Home Application Form for Membership $200.

Valid from January 1 to December 31, 2010

This includes a listing on the vacancy page
If you have more than one home use a separate application for each home.

Name of Home__________________________________________________________________

Address of Home_________________________________________________________________

Mailing address:__________________________________________________________________

Name of Owners_________________________________________________________________

Phone___________________________ fax____________________________________________

Email______________________________________________ web site______________________

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Phone___________________________ fax____________________________________________


Capacity_____________________  Signature of applicant___________________________________


Date of Application:_________________________________

Accepted date:_________________________ or denied____________________________________

Board Members signatures______________________________________________________

____________________________________________________________________________

_____________________________________________________________________________

Mail check payable to: Regina and District Personal Care Home Association
and mail to
Box 37191
Regina
S4S 7K4

“member” means a Saskatchewan resident who owns and operates a licensed

personal care home with typically 15 residents or less that is not associated with

an independent and/or assisted living complex.

All current members of the Association as of June 8, 2006 with personal care

homes with more than 15 residents shall be grandfathered.