Please Print this page and mail application to :
Wendy Bowers
AALTP Membership
1631 Grandview Ave
Utica NY 13502
315-733-4983
AALTP
APPLICATION FOR MEMBERSHIP
Membership fee of $35.00 payable to AALTP must accompany application
Please print all information.
Name_______________________________
Home Address_________________________
_____________________________________
Home Phone___________________________
Facility_______________________________
Address____________________________
__________________________________
Facility Phone________________________
o Adult Home
o SNF
o Senior Citizen Center
o Assisted Living
o Adult Day Care
o Other____________________________
Number of elderly served_______________
Where would you like to receive your AALTP news? HOME___ WORK___
Name of other professional associations you are a member of________________
______________________________________________________________
New Member____ Renewal____