Trial TEST ARF/RCFE 6Beds Membership A State of California Non-Profit Organization (NPO) Facility Name*Please provide at least 1 facility information you operate.Facility Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Facility WebsiteFacility type* RCFE ARF CommentsIf you are in the process of applying, you can join 6Beds. Please share where you are in the process of setting up you care home. Facility County*Facility/Primary Contact* First Last Primary Contact Email Address* Primary Contact Mobile Phone Number*Alternate Phone NumberLicensee Name*Primary Operator/Owner*Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How many RCFE facilities do you operate?*Please enter a number from 0 to 25.How many ARF facilities do you operate?*Please enter a number from 0 to 25.Choose Membership* $600 – Annual Membership Payment $300 – Semi-Annually Payment $150 – Quarterly Payment Total $0.00 This field is hidden when viewing the formFree Trial I’d like to sign up for the 60 day FREE trial Credit CardCard Details Cardholder Name Membership Terms I agree to the following terms: 1) 6Beds membership dues is $600 annually, $300 semi-annually and $150 quarterly. 2) Membership fees are payable by credit card and the member’s chosen payment frequency of annually, semi-annually or quarterly 3) I understand that I can cancel the membership on or after the anniversary date; 4) Membership cannot be cancelled prior to the anniversary date. I acknowledge that the origination of automatic electronic payment to my account must comply with the provisions of U.S. law. 5) I certify that I am an authorized user of this credit card account and will not dispute the scheduled transactions with my credit card company; so long as the transactions correspond to the terms indicated in this authorization form. 6BEDS is a Mutual Benefit NON-PROFIT Corporation. Part of the membership dues is tax-deductible (consult with your tax advisor). Membership dues are non-refundable.Signature* Δ
