2026 New Member Application

2026 NEW Member Application Form

Step 1 of 3

Name of Organization(Required)

Address(Required)

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

Organization Phone Number(Required)

Who serve as the InterHab Primary Contact?(Required)

First Last

Primary Contact Email(Required)

Primary Contact Cell Phone(Required)

Who will serve as the InterHab Alternate Contact?(Required)

First Last

Alternate Contact Email(Required)

Alternate Contact Cell Phone(Required)

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

First Last

Email(Required)

How many employees do you have?(Required)

How many individuals do you serve?(Required)

What counties do you provide services for?(Required)

2026 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 persons 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 0.1% for all audited wages over $1 million.
Minimum dues are $800.

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

Total amount of dues to be paid(Required)

Dues Payment Preferences

Dues may be paid in the following manner:

Annual (due by 1/1/2026)
Semi-Annual (installments due 1/1/2026 and 7/1/2026)
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

*Once your application has been approved by the Board of Directors you will be notified, and an invoice will be sent for your membership dues. Organizations will be automatically invoiced for all subsequent payments.

If you have any questions, please contact Janet at janet@interhab.org

*Please note that InterHab participates in ANCOR’s “100% membership” plan. InterHab members are 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.

Commitment to Ethical Practices

InterHab as an Association and its members commit to the following principles in the fulfillment of responsibilities to the individuals and families served; our interactions with one another; and in our role as community members. We endeavor to adhere to the highest ethical standards and integrity. As a member of InterHab, each organization shall:

Develop, adopt, and actively promote an agency specific statement of ethical conduct – to be on file with the InterHab office for membership reference;
Provide quality supports and services designed to meet the needs of the individual with emphasis on promoting systems and funding that result in the maximization of freedom and control that someone can bring to their life; and in a manner that stresses integrity, compassion, and respect for individual differences and choice;
Respect the privacy of persons served and protect the rights of confidentiality in all matters as they relate to the provision of supports and services;
Work diligently to foster a climate of trust between InterHab member organizations by safeguarding all information that may compromise the integrity of InterHab or any one of its member organizations;
Give preference to professional responsibility over any personal interests in all actions;
Advocate for, adopt, and affirm standards that promote positive outcomes for people before corporate or bureaucratic advancement;
Work cooperatively with other InterHab members in the development of ideas, findings, concepts, understanding, knowledge and practices to further promote a seamless statewide system of locally responsive community supports;
Encourage and advocate for the protection of the individuals served and the community network as a whole against unethical and/or illegal practices or actions by other individuals or organizations engaged in providing supports;
Advocate for and actively demonstrate a commitment to program practices that do not discriminate because of race, color, religion, age, sex, sexual orientation, disability, or national ancestry and shall work to eliminate or prevent such discrimination within the community; and
Serve as a responsible steward for public and private funds; operating in a manner that is transparent and in compliance with all applicable licensure requirements, auditing guidelines and community standards.

I agree to the standards and procedures set forth in the above statement:

Agreement(Required)

I agree to adhere to these policies.