Association of Senior Referral Professionals of Washington

Thank you for your interest in joining the Association of Senior Referral Professionals of Washington. Membership is open to companies that provide senior housing and care referrals, as well as organizations that support the work of referral professionals. Membership follows the company rather than any individual employee.

Annual membership fees are non-refundable. All applications are reviewed by the Board of Directors, and you will be notified once your membership has been processed. Renewal is due each year on the date your membership is approved.

Referral Agency applicants must also submit the following documents with their application:

Washington State business license
Disclosure of Service
Health Care Release form
Proof of professional liability insurance

Please mail or email all required materials to:

Abby Durr
Treasurer, ASRP of WA
1567 Highlands Dr NE, STE 110 #205
Issaquah, WA 98029
abby@silveragecare.com

Thank you for your interest in joining the Association of Senior Referral Professionals of Washington. Membership follows the company rather than individual employees.

Membership fees for 2025 and after (non-refundable):
• Senior Referral Company: $250 per year
• Affiliate Membership: $200 per year

Referral Agency (Senior Referral Company) applicants must also email the following documents:

Washington State business license (state license only)
Disclosure of Services
Health Care Release form
Proof of professional liability insurance

Please mail or email all required items to:

Abby Durr
Treasurer, ASRP of WA
1567 Highlands Dr NE, STE 110 #205
Issaquah, WA 98029
abby@silveragecare.com

A Senior Referral Professional Membership entitles the company to one vote on Association matters. Affiliate Members do not have voting influence. Each company may list up to three employees under its membership. You will be notified after the Board of Directors reviews your application at its next monthly meeting. Membership renewal is due yearly from the date your membership is approved.

Business Name

DBA

Address

City

Zip

Phone

Website

Service Areas

Primary Contact (Name/Title)

Primary Contact Email

Secondary Contact (Name/Title)

Third Contact (Name/Title)

Please check this box if you are applying as a Referral Agency.
Referral Agency Members must currently provide referral services within the senior housing and care industry in Washington. By checking the box, you acknowledge that your company is required to comply with the Elder and Vulnerable Adult Placement Referral Agency Act (RCW 18.330), and that eligibility for membership is based on meeting these requirements. Compliance includes, but is not limited to, the following:

Disclosure of services
Authorization to obtain and release medical information
Intake form
Community or provider profiles updated every 12 months
Contracts with providers, including fees and refund policies
Professional liability insurance with a minimum coverage of one million dollars
Background checks for all employees as required
Understanding of provider credentials and enforcement status
Compliance with all record-keeping requirements
Understanding that the company and its employees are Mandatory Reporters

Please check this box if you are applying as an Affiliate Member.
Affiliate Members must offer services that support the work of referral professionals or provide products or services to the senior housing and care industry within the state of Washington.

By signing below you are indicating that you have authorization to agree to the above for your company and that your company is in compliance with the Elder Referral Act RCW 18.330.

Signature

Business Name

DBA

Address

City

Zip

Phone

Website

Service Areas

Primary Contact (Name/Title)

Primary Contact Email

Secondary Contact (Name/Title)

Third Contact (Name/Title)

Please check this box if you are applying as a Referral Agency.
Referral Agency Members must currently provide referral services within the senior housing and care industry in Washington. By checking the box, you acknowledge that your company is required to comply with the Elder and Vulnerable Adult Placement Referral Agency Act (RCW 18.330), and that eligibility for membership is based on meeting these requirements. Compliance includes, but is not limited to, the following:

Disclosure of services
Authorization to obtain and release medical information
Intake form
Community or provider profiles updated every 12 months
Contracts with providers, including fees and refund policies
Professional liability insurance with a minimum coverage of one million dollars
Background checks for all employees as required
Understanding of provider credentials and enforcement status
Compliance with all record-keeping requirements
Understanding that the company and its employees are Mandatory Reporters

Please check this box if you are applying as an Affiliate Member.
Affiliate Members must offer services that support the work of referral professionals or provide products or services to the senior housing and care industry within the state of Washington.

By signing below you are indicating that you have authorization to agree to the above for your company and that your company is in compliance with the Elder Referral Act RCW 18.330.

Signature

Business Name

DBA

Address

City

Zip

Phone

Website

Service Areas

Primary Contact (Name/Title)

Primary Contact Email

Secondary Contact (Name/Title)

Third Contact (Name/Title)

Please check this box if you are applying as a Referral Agency.
Referral Agency Members must currently provide referral services within the senior housing and care industry in Washington. By checking the box, you acknowledge that your company is required to comply with the Elder and Vulnerable Adult Placement Referral Agency Act (RCW 18.330), and that eligibility for membership is based on meeting these requirements. Compliance includes, but is not limited to, the following:

Disclosure of services
Authorization to obtain and release medical information
Intake form
Community or provider profiles updated every 12 months
Contracts with providers, including fees and refund policies
Professional liability insurance with a minimum coverage of one million dollars
Background checks for all employees as required
Understanding of provider credentials and enforcement status
Compliance with all record-keeping requirements
Understanding that the company and its employees are Mandatory Reporters

Please check this box if you are applying as an Affiliate Member.
Affiliate Members must offer services that support the work of referral professionals or provide products or services to the senior housing and care industry within the state of Washington.

By signing below you are indicating that you have authorization to agree to the above for your company and that your company is in compliance with the Elder Referral Act RCW 18.330.

Signature

Membership Application