2026 Membership Renewal

Name of Organization(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Who will serve as the Primary Contact for InterHab(Required)

First Last

Email Address for Primary Contact(Required)

Primary Contact Cell Phone(Required)

Who will serve as the Alternate Contact for InterHab

First Last

Email Address for Alternate Contact

Alternate Contact Cell Phone

Please list one person's name and email address where you would like us to send your invoices(Required)

First Last

Email for invoices(Required)

How many employees do you have(Required)

How many individuals do you serve(Required)

What counties do you provide service for(Required)

Audited staff salaries and wages for the last full year(Required)

2025 Membership Dues

Dues are calculated using your organization's salaries and wages paid to full-time and part-time employees for the most recent full year of operation. Wages paid to individuals served should not be included in this total. Dues are calculated as follows: - For all organizations, dues are equal to 1.2% of audited staff salary from the most recent full year of operation; - For organizations with audited staff salaries above $1 million, dues are 1.2% of audited salaries for the first $1 million and .1% for all audited wages over $1 million. - Minimum dues are $800.00.

Total amount of dues to be paid(Required)

Dues Payment Preferences

Dues may be paid in the following manner: 1) Annual (due by 1/1/2026) 2) Semi-Annual (installments due 1/1/2026 and 7/1/2026) 3) Quarterly (installments due 1/1/2026, 4/1/2026, 7/1/2026 and 10/1/2026)

How will you be paying your dues?(Required)

Annually

Semi-Annually

Quarterly

Members will receive invoices for their first 2026 dues payment in December 2025. Annual dues/first installment payments will be due January 1, 2026. Organizations will be invoiced for all subsequent payments.

*Please note that InterHab participates in ANCOR’s “100% membership” plan. InterHab members will be assessed an additional amount to cover their portion of this membership plan. Individual portions are calculated based on the organization’s percentage of InterHab’s total dues revenue. This additional amount will be invoiced with the organization’s first payment of 2026.