"Without PACE, I would not be able to keep working and care for my mother. Without the day program, I don't think I would have a life. It's wonderful."

Registration for More Information about PACE

If you are not an NPA member, please complete and submit the following information to access on-line resources about developing and expanding PACE. Enter a username and password that you can easily remember so that you may return to this portion of the web site in the future.

If you are an NPA member or have registered before and cannot remember your username and password, please contact NPA at rhondar@npaonline.org.

Thank you!

Please complete this form to register for access. Thank you.

Fields marked with * are required.

Username:

Password:

Confirm Password:

First Name:

Last Name:

E-mail:

Organization Name

Title

StreetAddress

City

State

Zip

Phone

Fax

Please select the category that applies to you:
Student	State Agency	Researcher
Local Agency	Interested Health Care Provider	Advocate
Consumer	Consultant	Federal Agency

Please select one of the following:
We are not currently involved in understanding, assessing or developing PACE, but may be interested in doing so in the future.
We are planning and developing a PACE program.
We are assessing the possibility of starting a PACE program.
We are in the process of understanding the PACE model of care.

Organization Profile

Is your organization:

Single Site or Multi-Site

For-Profit or Not-for-Profit

Stand Alone Provider or Health Care Network

Please check all those that best describe your organization:
Other (please describe)		Nursing Home
Continuing Care Retirement Community		Federally Qualified Health Center
Community Organization		Community Health Center
Adult Day Care		Assisted Living Facility
Area Agency on Aging		Health System
Hospital		Home Health Agency
Home Care Agency		Senior Housing Provider
Senior Center

Are you a tribal health organization?

Yes No

Does your service area include rural areas?

Yes No

How did you hear about PACE?

Are you contacting NPA on behalf of someone else?

Yes No

If yes, Name of Organization or Contact:

NPA periodically provides updates and notices regarding upcoming events to organizations that are interested in PACE. Please check below if you give permission for NPA to share this information with you.

Yes, NPA may periodically contact me with PACE updates and information about upcoming events.

NPA periodically makes available to state officials and policymakers information regarding the potential demand for state agencies to assist new PACE organizations. Additionally, we are occasionally asked to assist interested organizations in finding partnering and referral opportunities in their communities. Please check below if you give permission to share your contact information with these entities.

Yes, NPA may share my contact information with state officials, policymakers, and interested organizations with partnering and referral potential.

NPA periodically makes available to its members (which includes Technical Assistance Centers as well as other membership categories) a listing of organizations that are interested in developing or exploring the development of a PACE program. Please check below if you give permission to share your contact information with these entities.

Yes, NPA may share my contact information with its members.

For more information, please review our Privacy Policy.

Copyright 2002 National PACE Association. All Rights Reserved.