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Interested in joining Green Country Healthcare Association in its mission to help promote cooperation, coordination and understanding between its members, health care professionals, institutions, associations, groups, individuals and public agencies? Please fill out our membership application below!

Yearly membership dues for the Green Country Healthcare Association is $250. Please make your $250 check payable to GREEN COUNTRY HEALTHCARE ASSOCIATION (GCHA) and mail check to:

Green Country Healthcare Association
10912 E. 14 th Street
Tulsa, OK 74128
E-MAIL:administrator@tulsanc.com
WEBSITE: www.greencountrycaresforseniors.org

Complete all information below. To be listed in the directory, the dues must be received by November 15th. Information will be printed as submitted in the GCHA online membership directory.

If you’d like to update your information, please contact support@www.new.greencountrycaresforseniors.org.

Membership Info
Organization*
Membership Type*	Membership Type Active Associate
Administrator/Representative
Address
City
State
Zip Code
Telephone
Fax
Email
URL
Number of Beds
Services Offered	Services Offered Skilled/Rehab Facility Developmentally Challenged Alzheimer’s/Dementia Unit Assisted Living Independent Living Sub-Acute Ventilator Residential Respite Care Veteran Approved Contract Private Pay Medicare Certified Medicaid Certified Insurance Inside Designated Smoking Area Smoke Free Pharmaceutical Hospice
Membership Contact Name*
Membership Contact Telephone
Membership Contact Email
Verification*	4 + 9 = ? Please verify that you are an actual person filling out this form.

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Membership Info