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Membership
New Membership Application with CC Payment
Step
1
of
7
- PRC Information
14%
Name of Organization:
(Required)
Mailing Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Is your physical address different from your mailing address?
(Required)
No
Yes
Physical Street Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Executive Director
(Required)
Executive Director Email
(Required)
Executive Director Phone
(Required)
Client-Facing Website
(Required)
Be sure to include "https://" before your domain.
Donor Website (if different from above)
Affiliations
(Required)
Heartbeat International
CareNet
ECFA
Life Matters Worldwide
NIFLA
Missouri Alliance for Life
No Affiliations
If Other Affiliations, please list here:
Medical Center/Clinic
Is your organization a medical center/clinic?
(Required)
Yes
No
Name of Medical Director
(Required)
Name of Nurse Manager
(Required)
Nurse Manager Email
(Required)
Nurse Manager Email
(Required)
Which medical services do you currently provide?
(Required)
Ultrasound
STI/STD Testing
Prenatal Care
Abortion Pill Reversal
Maternity Home
Do you have a maternity home?
(Required)
Yes
No
Name of maternity home
(Required)
Is your home licensed in the state of Kansas?
(Required)
Yes
No
Total Number of Beds
(Required)
Satellite Locations
Do you have any satellite locations?
(Required)
Yes
No
Satellite 1 Physical Location
(Required)
Satellite 2 Physical Location
Satellite 3 Physical Location
Mobile Units
Do you have any mobile units?
(Required)
Yes
No
How many mobile units does your center have?
(Required)
Please list cities and/or counties where you use your mobile units
(Required)
Membership Acknowledgement
Membership Agreements
ALL BOXES MUST BE CHECKED FOR YOUR MEMBERSHIP TO BE APPROVED.
Life Alliance Kansas member understands that membership status may be revoked if these standards are violated in such a way that there is no remedy or repentance.
Commitment of Care
Life Alliance Kansas members agree to the following Commitment of Care:
1. Clients will be served without regard to age, income, nationality, religious affiliation, disability or other arbitrary circumstances.
2. Clients are treated with kindness and compassion.
3. Clients always receive honest and accurate answers to their questions.
4. Client pregnancy tests are distributed and administered in accordance with all applicable laws.
5. Client information is held in strict and absolute confidence. Client information is only disclosed as required by law and when necessary to protect the client or others against imminent harm.
6. Clients receive medically accurate information about pregnancy, fetal development, lifestyle issues and related concerns.
7. Life Alliance Kansas members do not offer, recommend or refer for abortions or abortifacients; but are committed to offering medically accurate information about abortion procedures and risks.
8. All advertising and communications are truthful and accurately describe the services offered.
9. All staff and volunteers receive proper training to uphold these commitments of client care.
Agreement: Standards of Membership
(Required)
I have read, agree, and my organization is in compliance with Life Alliance Kansas' Standard of Membership
(Required)
Standards of Membership within Life Alliance Kansas
In light of the cultural battle in the state of Kansas for the hearts of men and women in crisis as well as their children, it is vital that Life Alliance Kansas members operate with integrity and excellence in client care. The way these members function and communicate their services holds significant importance. Upholding high standards of integrity is essential for their success. As representatives of Jesus Christ, maintaining a reputation beyond reproach is a Biblical mandate.
Given the cultural and political environment in which we operate, it is imperative that Life Alliance Kansas members embody the principles of integrity found in God's Word.
The integrity of the upright guides them, but the crookedness of the treacherous destroys them.
Proverbs 11:3
Finally, brothers, whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is commendable, if there is any excellence, if there is anything worthy of praise, think about these things.
Philippians 4:8
Therefore, pro-life organizations that desire to become a member of the Life Alliance Kansas (LAK) should agree to uphold and operate under the following Standards:
Member Foundation Documents:
1. LAK member is incorporated under the laws of its respective state and operates in compliance with its Articles of Incorporation, By-laws, and all applicable regulatory and legal requirements.
2. LAK member will adhere to a written purpose or mission statement.
3. LAK member will operate in accordance with a statement of faith.
4. LAK member will follow established policies and procedures.
Member Operational Integrity:
1. LAK member will be governed by a board of directors that meets regularly.
2. LAK member will maintain adequate insurance coverage.
3. LAK member will adhere to truthfulness in all aspects of its operations.
4. LAK member will ensure its operations remain within ethical and legal boundaries.
5. LAK member will implement a standard format for volunteer and staff training and orientation to ensure adequate preparation.
6. LAK member will provide a safe environment by screening all volunteers and staff who interact with clients.
7. LAK member will maintain records and statistics of clients served.
Member Financial Integrity:
1. LAK member will conduct its fundraising activities and financial transactions with integrity.
2. LAK member will maintain a system of financial accountability in compliance with generally accepted accounting principles.
3. LAK member's financial records will be reviewed at least quarterly by its board of directors or governing board.
Member Biblical Integrity:
1. LAK member adheres to Biblical principles in regards to marriage between one genetic man and one genetic woman only and sexual intimacy is to occur only within the context of marriage as defined in scripture.
2. LAK member recognizes the calling from God of each of the members, and will give grace to those whose vision or model differs from their own.
3. LAK member opposes the use of violence, vandalism or illegal activity to achieve the goal of preserving, promoting and defending the sanctity of life.
4. LAK member shall be in agreement with Life Alliance Kansas' Statement of Faith, as well as their Mission and Vision.
Member Medical Integrity:
1. LAK member providing medical services will function under licensed physician and only utilize licensed medical professionals for procedures and ultrasounds
2. LAK member without a principle physician will not present themselves as a clinic or provider of medical services
3. LAK member utilizes only trained and licensed medical professionals to perform medical procedures
4. LAK member carries adequate and appropriate malpractice insurance and is able to produce evidence of that insurance upon request LAK member understands that membership status may be revoked if these standards are violated in such a way that there is no remedy or repentance.
Agreement: Commitment of Care
(Required)
I have read, agree, and my organization is in compliance with Life Alliance Kansas' Commitment of Care
(Required)
Signature of Executive Director or Board Chair/President
(Required)
Typing your name will be considered a legal signature.
All boxes must be checked to proceed.
Dues
Select Your Organization's Annual Budget
(Required)
$0 to $250,000 (Annual Fee is $100)
Above $250,000 (Annual Fee is $250)
Org is less than 1 year old (Annual Fee is Free)
PRC Level 1
Price:
PRC Level 2
Price:
Total
Billing Contact Name
(Required)
First
Last
Billing Contact Email
(Required)
Is your billing address for this payment method different from your mailing address?
(Required)
No
Yes
Billing Address
(Required)
Street Address
Address Line 2
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