Membership Application Agreements


Privacy and Disclosure Policy Acknowledgments

Non-Confidential Business Information: Certain business information we collect from Applicants and Members is considered public information by the Association (rather than information about you individually, such as your personal or financial information, etc.). For these purposes, we have defined “Non-Confidential Business Information” as any information for public review that identifies, or may identify, a company, its business practices, policies and procedures, its employees, or an individual contact at a company or that allows others to contact a company or an individual contact at a company that is not considered by the Association to be “Confidential Business Information.”

Member’s Profile: We also collect Business Information when you submit an Application for process by the Association. This information includes contact information and certain other information about you and/or your business and the services your business may provide. We use this information in accordance with this policy to identify you, your business, and to process your Application. In addition, this Information is used to create a “Member Profile” that is posted on the Association’s Web Site and available for the public to review.
Release Statement: I, the undersigned, grant the Arizona In Home Care Association (the “Association”), and/or its authorized agents, the rights to use the Non-Confidential Business Information contained herein, as defined above, for informational, publicity, or promotional purposes without prior notification. I understand that this Business Information may appear in printed materials published by the Association, on the Association’s Web site, in the Association’s presentations or exhibits, in newspapers or magazines, or on television. I agree to hold the Association and its Members harmless from all claims related to the Association’s or its agents’ use of this Non-Confidential Business Information for these purposes. I also agree that the Association is under no obligation to me or any other party to use this Non-Confidential Business Information. By my signature below, I represent that I have read and fully understand this Application for Membership Form.

Application Verification Statement: I hereby authorize the Arizona In Home Care Association, it agents, officers, directors, staff, or private investigators, to make inquiries, either by written communication, telephone, electronic, in person or otherwise, to any current or former business associate, governmental agency, educational institution, military establishment, relative or any other persons or entities knowledgeable of backgrounds of the individuals listed on this Application as to their prior history, without limitation, their: criminal history, business records or personal background; Corporate directorship/ownership, interest in business(es), nature of business of business dealings; prior claims, lawsuits, settlements; educational background, licenses, and certifications, work experience, nature of duties, performance levels; reliability, responsibility, honesty, integrity, civility, and any other measures of their character or personality.
In consideration of the furnishing of any such information by any party contacted by or on behalf of Arizona In Home Care Association, I and the business entity I represent, specifically waive any confidential relationship or privacy right which may exist for my (our) benefit and completely release the Arizona In Home Care Association, and the party(ies) contacted from any responsibility or liability for damages or other injuries which may occur as a result of the release or disclosure of this information. I, and the business entity I represent, agree to indemnify and hold harmless anyone involved with the conduction of this investigation of my, or the business entities, background from any and all liabilities or claims in connection therewith, photocopy, fax or electronic copy of this instrument bearing my signature shall be equally legally valid as the original.

Applicant Verification

I certify that to the best of my knowledge, that the information provided herein is accurate and complete. I further agree, in the event the business I represent becomes a Member of the Association that all disputes and claims, individual or severable, involving this Membership will be submitted to the Association’s Board of Directors for final resolution. The decision rendered by the Board of Directors regarding any Member dispute or claim is binding, final, and cannot be appealed.xpulsion from AZNHA.

Agreement to Comply

I, and the business entity I represent, agree to comply with the Association’s Code of Business Ethics & Credentialing Standards of Service Agreement as set forth above. I understand and agree that failure to comply with this Agreement can result in an investigation into a member’s conduct, and can result in disciplinary measures by the Association, including suspension or expulsion from AZNHA.

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