Become a Member of HIPSS

HIPSS Mission...“To improve the quality of life for the seniors we have the privilege of serving, by improving relationships and communication between providers; expanding their knowledge base and resources to effectively serve our seniors with the utmost dignity and respect.”

If you would like to become a member of HIPSS, please fill out the following information and click “submit” for Board review.

Company Name*
Website
Service Category*
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Office Phone*
Fax Phone
Primary Contact Name*
First Last
Primary Contact Title
Primary Contact Email*
Primary Contact Phone*
What is your main reason for joining HIPSS?*
What contributions can your company make to HIPSS as it correlates to our Mission Statement?*
Committee Responsibility

Each approved member is required to participate on one of three committees: Education, Community Outreach, or Membership. Please select a committee preference for each applicant.
Quantity*
Please enter a number from 1 to 4.
Company Representative(s) That Will Attend Meetings*
First Last
Commitee Preference*
Additional Member
First Last
Commitee Preference
Additional Member
First Last
Commitee Preference
Additional Member
First Last
Commitee Preference

Become a Member of HIPSS

Committee Responsibility