Member Marketplace Application

Complete the form below for each product or service your agency would like to feature in the USAging Member Marketplace. All submissions are subject to an internal USAging review.

Please note: Though the Member Marketplace is housed on USAging's website, USAging does not endorse any of the products or services featured in the Marketplace.

Agency Information
Please enter information about your agency in the fields below.

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* 1. Name of Agency

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* 2. Name of Submitter

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* 3. Email Address of Submitter

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* 4. Agency Website

Product or Service Information
All information listed below will be listed in the M2M Marketplace.

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* 5. Name of Product or Service

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* 6. Official Owner and Operator of the Product or Service (e.g., the AAA or AAA's governing authority)

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* 7. Contact Person for Product or Service (First Name, Last Name)

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* 8. Email Address for Product or Service Contact Person

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* 9. Phone Number for Product or Service Contact Person

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* 10. Web Address for Product or Service

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* 11. Photo: Please upload a photo representing your agency's logo or the logo for your product or service. Files should be in JPEG or PNG format.

PNG, JPG, JPEG file types only.

Choose File

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* 12. Overview: Please provide a three-to-five sentence description of the product or service being offered.

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* 13. Disclaimer: I attest that the product or service I have submitted is owned and operated by a AAA or Title VI program (or a AAA or Title VI governing authority), and that my agency is a AAA or Title VI USAging member in good standing. I understand that my submission is subject to an internal USAging review. USAging will promote the Member Marketplace on its website and through communications, but USAging does not endorse any of the featured products or services.

I agree to and understand all of the rules outlined above. (Still have questions? Contact USAging's Communications Director at jleavelle@usaging.org.)

If approved for the Member Marketplace, my agency/organization will submit payment in a timely fashion. (Contact rlevine@usaging.org.)

For more information, please visit our FAQ page.