One Voice Texas :: Membership Application

One Voice Membership Application

Getting Started

Download and print a hardcopy application form,

use this electronic form to apply for One Voice membership.

Please submit a complete membership application.

Fields noted with asterisk (*) indicate required field or check box.

Date of Application*

Part I: General Information

Organization

Primary Contact* Contact Title

Address* City* State*

Zip*

Phone* Fax eMail*

Web Address

Executive Director/CEO eMail

Part II: Workgroup Selection

Click checkbox(es) to select the workgroup(s) in which your
organization will participate; you may choose more than one.

		Physical Health		Behavioral Health

		Early Childhood Education		Public Education

		Basic Needs		Child Welfare

		Community Care for Seniors and Persons with Disabilities

Part III: Membership Type & Dues Structure

First, click button to select appropriate membership type;

Then, click button corresponding to dues requirement.

Identify the dues for your organization, make your check
or money order payable to One Voice and mail to:

One Voice
4550 Post Oak Place Drive, Suite 100
Houston, Texas 77027

*Partnership Member

Click button to select this membership type

(Private or non-profit health & human services organization;
one vote per organization)

Dues are calculated on the following organizational budget:

Annual Budget	Annual Dues

<$500,000		$150.00
$500,000 - $1.99 M		$250.00
$2.0 M - $4.99 M		$350.00
$5.0 M +		$500.00

*Partnership Member Voting Representative

If your organization wishes to name a specific individual
to be your voting representative, enter name below:

Named Voting Representative:

Resource Member

Click button to select this membership type

(Public or government organization; no formal voting privileges)

$150.00

if organization receives funding from sources other than
government entities

$000.00

if budget is based on government funds only

Associate Supporting Organization

Click button to select this membership type

(Organization/business that supports One Voice's mission and
priorities; no formal voting privileges)

$250.00

Associate Individual

Click button to select this membership type

(Individual who is not employed by an eligible Partnership or
Resource Member, who supports One Voice's mission and
priorities; no formal voting privileges)

$50.00

Part IV: Application Agreement

* By submitting this application form, I am indicating that I
have read and agree with the One Voice Membership Guidelines.

[Note: Form will not "send" if Agreement box is not checked.]

Questions before submitting this application?

Laurie Glaze
Executive Director
713.333.2232

Candace Spencer
Administrative Assistant
713.333.2204

One Voice Texas: A Collaborative for Health and Human Services - Advocates for Comprehensive High Quality Health and Human Services

4550 POST OAK PLACE DRIVE, SUITE. 100 HOUSTON, TEXAS 77027 Office: 713.333.2232 or 713.333.2204 Fax: 713.333.2220