Thank you for your interest in joining the Maine Council on Aging. Please complete this online application. Starred fields require an answer. Organization Information Organization Name* Address Line 1* Address Line 2 City* State* Zip* Membership Type MCOA offers several different membership types. Please indicate whether you will be selecting a Membership or a Sustaining Patron Membership. After selecting your membership type, you will be able to select a specific membership level. MembershipSustaining Patron Membership Annual Membership Levels MCOA’s membership year is October 1 through September 30. Dues for members joining after January 1st will be prorated. Please contact us at 207-592-9972 or email Leslie Roberts at lroberts@mainecouncilonaging.org if you have questions about which level is right for your organization. For-profit Corporation - $700Non-profit Entity or Educational Institution - $500Sole Proprietor - $250Aging in Place Initiative - $250Municipality - $250 Sustaining Patron Membership Levels Thank you for supporting MCOA at the Sustaining Patron level. If you have any questions about the benefit levels, please email Becca Howes at rhowes@mainecouncilonaging.org. Katahdin Patron - $8,000Sugarloaf Patron - $5,000Bigelow Patron - $2,500Saddleback Patron - $1,500 Primary Contact First Name* Last Name* Job Title* Email Address* Phone Number* Billing Contact Same as Primary ContactProvide different billing information Billing Information First Name Last Name Job Title Email Address Phone Number Additional Employees Your membership includes up to three additional employees. Please complete all fields for each additional contact. Contact 1 Contact 2 Contact 3 Referral Were you referred to us by an MCOA member? If so, please tell us who it was. Name Our Mission The MCOA draws upon wisdom, experience, and data to influence policy, educate stakeholders, and advance initiatives that move us towards our vision. We commit to including the voices, wisdom, and lived experience of diverse older people. Membership Agreement My organization supports the mission of the Maine Council on Aging and will carry out its responsibilities as a member in good faith. Name* Date* Have Questions? Call 207-592-9972 or email Leslie Roberts at lroberts@mainecouncilonaging.org. Thank you.
