Provider Application for 60/60 Tour

Only 60 Spots Available!

Are you ready to celebrate LeadingAge California's 60th Anniversary? Join LeadingAge California's CEO, Jeannee Parker-Martin as she tours member communities throughout the state this March!

Apply to be one of the stops (virtually of course!) she makes on this tour. She'll highlight your community, leadership, and residents in a video chat tour that will be featured on LeadingAge California's YouTube channel and at the May 2021 Virtual Annual Conference.

Apply today to be one of the lucky communities to be featured!

Question Title

* 1. Contact Person (receiving communication regarding this project)

Name

Title

Email Address

Phone Number

Question Title

* 2. Provider Information

Organization:

Address

City/Town

State/Province

ZIP/Postal Code

Country

Web Address

Phone Number