Home Care & Hospice Alliance of Maine 2025-2026 Membership Application

Membership Year: June 1, 2025 - May 31, 2026

First Name:

Last Name:

Email:

Agency/Company:

Address:

Website:

Medicare-Certified Home Health Agency

Medicare-Certified Hospice

State Licensed Home Care Agency

State Licensed Personal Care Agency

Associate/Allied (provides goods/services but not direct care in the home)

Individual/Sole Proprietor (appropriate for self-employed consultants)