Alliance Application

For Acceptance into an Alliance

APPLICATION PROCESS: Complete the application and submit your information to Professionals Helping Seniors, LLC (PHS).

Following acceptance by PHS, you will be introduced at the next ALLIANCE meeting. All Sections MUST Be Completed.

You may also click here to download member application.

Name:
Email:
Company:
Phone:
Secondary Phone:
Address:
Address2:
City:
State:
Zip:
ALLIANCE Name:
Profession: Please indicate your primary profession or professional category.
If other:
Have you ever been accused or convicted of a felony?
Yes
No
Are you currently, or have you within the past ten years, been a defendant or respondent in any criminal proceeding relating to your professional or business conduct, or are you currently named as a party in any such action?
Yes
No
Within the last ten years, have you been a defendant or respondent in a civil action, which includes, but is not limited to, a lawsuit, arbitration, or mediation relating to your professional or business conduct, or are you currently named as a party in any such action?
Yes
Within the last ten years, have you ever had a license, permit, certificate, registration, or membership denied, suspended, revoked or restricted by any governmental, regulatory, or administrative body, or has any such body censured, fined, restricted or reprimanded you?
Yes
No
Has any governmental, regulatory, or administrative body named you as a subject of an investigation or complaint?
Yes
No
Have you ever been censured, fined, reprimanded, or otherwise disciplined by any professional credentialing organization to which you did or do belong, or has any such organization named you as a subject of an investigation or complaint?
Yes
No
Provide explanation for any “Yes” answers above in the field provided below.
By checking this box, I affirm that my answers to questions 1-6 above are true and, if applicable, my explanation for any “Yes” answers are also true.
I agree
I understand and agree to follow the PHS Code of Ethics, Policies, and Guidelines. By completing and submitting this application, I authorize PHS to conduct a background check.
I agree
I hereby declare and certify that all statements contained in this application and any accompanying documents are true and correct, and that any misrepresentation or false statement may be grounds for rejecting my application or, if discovered after my application has been accepted, immediate termination at PHS discretion without any reimbursement. I further understand that my membership is conditional and can be terminated at will.

PHS CODE OF ETHICS

Upon acceptance to the PHS ALLIANCE, I agree to abide by the following Code of Ethics during my participation in the organization:
  • I will provide services in accordance with local and industry quality standards at the prices I have quoted.
  • I will be truthful with the members and their referrals.
  • I will build goodwill and trust among members and their referrals.
  • I will take responsibility for following up on the referrals I receive.
  • I will display a positive and supportive attitude with PHS ALLIANCE members.
  • I will live up to the ethical standards of my profession.
Professional standards outlined in a formal code of conduct for your profession supersede the above standards.

PHS POLICIES AND GUIDELINES

Arbitration: All disputes arising out of or related to this Agreement or the member’s participation in PHS shall be resolved by binding arbitration in Denver, Colorado, and in accordance with the laws of the State of Colorado. The Arbitration shall be subject to the Rules of the American Arbitration Association. This clause encompasses only disputes arising under this agreement between member and PHS and their officers, directors, agents and representatives.

Limitations on Liability: Not withstanding any other provisions of this Agreement, any liability to you involving PHS and their officers, directors, agents and representatives for any cause whatsoever arising out of or related to this Agreement and / or membership or participation in PHS and regardless of the form of action, will at all times be limited to the amount of monthly dues paid by you for the membership in PHS. Except in jurisdictions where such provisions are restricted, in no event will there by any liability to you or any third person for any indirect, consequential, exemplary, incidental, special or punitive damages.

Non-Compete: As an ALLIANCE member, you agree not to conduct activities in competition with PHS during your membership with the organization or for a period of one year after your participation and/or membership with PHS has ended, whichever is later (or the maximum period of time allowed by law, if earlier). Competing with PHS includes but is not limited to starting a competing organization, disclosing PHS information or materials, and communicating techniques or Trade Secrets to a competing organization.

Attendance: Attendance and participation at the ALLIANCE meetings is very important to the success of the ALLIANCE. If you have any questions regarding payment or processing of membership fees, please call PHS at 888-651-8810.