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Community Clinic Association of Los Angeles County

Affiliate Application

All applicants for affiliate are subject to approval by the CCALAC Board of Directors.
An Affiliate has no voting privileges, and may not participate in the Policy Advisory Group.

Categories & Fees

Nonprofit Providers – $1,200

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Includes: Participation in one (1) CCALAC work group or roundtable.
May participate in other work groups or roundtables for additional fees. (see below).

Other Nonprofits – $1,000

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Includes: May participate in other work groups or roundtables for additional fees. (see below).

For-Profit Corporations – $10,000

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Includes: May participate in other work groups or roundtables for additional fees. (see below).

Individuals – $500

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Includes: May participate in other work groups or roundtables for additional fees. (see below).

Students – $100

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Includes: May participate in other work groups or roundtables for additional fees. (see below).

Before You Start

If you are applying as an organization, please be sure you have the following documents ready before you start this application:

  • Federal Tax ID Number (if applicable)
  • Articles of Incorporation
  • Federal Tax Exemption as 501(c)3 (if applicable)
  • Most recent IRS form 990 (if applicable)
  • Lists of your Board of Directors, with officers noted
  • Bylaws
  • Electronic copy of logo

Affiliate Application


Work Groups and Roundtables

All applicants for affiliate are subject to approval by the CCALAC Board of Directors. An Affiliate has no voting privileges, and may not participate in the Policy Advisory Group.

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