New / re-activate membership application

Membership and Accreditation Policy

Achieving and maintaining Accreditation is required for Clubhouse International membership.

New Clubhouses (start-up or converting from a different service approach) are required to complete the Accreditation process within four years of becoming a member of Clubhouse International. This four-year timeframe allows sufficient opportunity to receive consultation, implement the Standards for Clubhouse Programs™, and participate in comprehensive Clubhouse training.

Returning Clubhouses will work with Clubhouse International to plan and schedule their next Accreditation as part of rejoining. Please note that the Accreditation calendar typically books 12 to 16 months in advance.

STEP ONE: PROVIDE/UPDATE YOUR INFORMATION

Membership Status (check one):

New Member Former Member (Re-activating Membership)

I acknowledge that, as a new Clubhouse (start-up or conversion), we are required to complete the Accreditation process within four years of joining and understand that this timeframe allows for consultation, implementation of the Standards for Clubhouse Programs™, and participation in comprehensive Clubhouse training.

I acknowledge that, as a returning Clubhouse, we will work with Clubhouse International to plan and schedule our next Accreditation as part of rejoining, and understand that the Accreditation calendar typically books 12 to 16 months in advance.

Clubhouse ID#: (former members only) Clubhouse Name: Street Address: City: US State:

Alabama Alaska American Samoa Arizona Arkansas Armed Forces Africa, Canada, Middle East, Europe Armed Forces America (except Canada) Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawai`i Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas US Virgin Islands Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

AUS State:

Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia

Province:

Alberta British Columbia Entre Rios Guangdong Jalisco Manitoba New Brunswick New Foundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Territories Yunnan

Postal Code: Country:

Select Country Albania Argentina Australia Austria Canada Denmark England Estonia Finland France Germany Ghana Gibraltar Hong Kong SAR, PRC Iceland India Israel Italy Japan Kazakhstan Mexico Nepal New Zealand Norway Papua New Guinea People's Republic of China Poland Republic of Ireland Republic of Korea Republic of Kosovo Republic of Macedonia Romania Russian Federation Scotland Slovak Republic South Africa Sweden Taiwan (Republic of China) The Netherlands Uganda United Kingdom USA

Continent

Select Continent Africa Asia Australia/New Zealand Europe Middle East North America South America

Clubhouse Phone Number: Clubhouse Fax: (optional) General Email: Website URL: Director's Name: Director's Phone Number: Director's Work Email:

Director's Portal Login Email: Director's Portal Login Password:

Password must have the following properties:

• Be between 8 and 15 characters in length
• Contain at least 1 number
• Contain at least 1 UPPER CASE character
• Contain at least 1 lower case character
• Contain at least 1 special character (such as #, ^, @, etc.)

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STEP TWO: ACCEPT YOUR MEMBERSHIP AGREEMENT

Check here to signify your agreement with the Clubhouse International Membership Agreement

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STEP THREE: PAY YOUR MEMBERSHIP DUES

Membership Dues Calculator:

Clubhouse International Membership dues are ¼ of 1% of the total Clubhouse budget from all sources. Example: Total budget: $400,000 x .0025 = $1000

Total Clubhouse Budget:

CALCULATE DUES

Clubhouse Dues:

$

Pay Online

Card Type:

Select Card Type Visa MasterCard Discover American Express

Cardholder First Name: Cardholder Last Name: Cardholder Street Address: Cardholder Zip Code: Card Number:

Expiration Month:

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Expiration Year:

Select Expiration Year 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034

CVV2:

Check and wire transfer payments: Include your Clubhouse name and note the payment reason (for Membership dues, Startup Training, etc.)

Pay By Check

Make checks payable in US dollars to Clubhouse International, and mail to:

Clubhouse International
845 Third Avenue 6th Floor
New York, New York 10022

Pay By Wire Transfer

Bank name: Capital One Bank
404 Fifth Avenue
New York, New York 10018
ABA #: 065000090
Swift Code (BIC): HIBKUS44
For credit to the account of Clubhouse International A/C # 7528097035

Verification: Please enter the numbers and letters shown here:

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BENEFITS OF MEMBERSHIP

• Worldwide exposure through Clubhouse International Directory and Resource Guide and through our website, www.clubhouse-intl.org and our social media channels, Facebook, Twitter and YouTube.
• Access to a database of over 1,000 articles and presentations about the Clubhouse model, and how to start, develop and sustain a successful Clubhouse in your community
• Ongoing communications: Clubhouse International Annual Report and monthly newsletter
• Active participation in the continual, consensus-driven process of evolving and updating our International Standards for Clubhouse Programs.™ These Standards are at the heart of the success experienced by Clubhouses around the world and provide the basis for assessing Clubhouse quality through Clubhouse International Accreditation™
• Access to the Clubhouse International Accreditation process, which is heavily subsidized by Clubhouse International
  • The process often includes ongoing technical support with the Clubhouse International Faculty team, a group of 90 experienced Clubhouse members and staff, who have undergone an intensive training course
  • Your Clubhouse may also receive ongoing formal support in the form of consultations, etc. from any of the 12 Clubhouse International global Training Centers. This service is for "at-cost" with fees established accordingly
• Interactive support for your specific questions and issues via our website and email exchanges with Clubhouse International staff/volunteers and a strong network of Accredited Clubhouses
• $100 discount per attendee at the biennial Clubhouse International World Seminar, which offers a unique opportunity to meet and gain knowledge from over 600 Clubhouse experts from around the world