Membership Application

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To join using our online application:

1. Fill out the form below, print out the form, and click on the “send” button.
2. Send check payable to North Texas TORCH to:

1724 Milestone Ridge
Lewisville, TX 75067

* Make sure your name and company/facility is included so that we may match your payment up with your application!

Membership Category

Facility Member: A facility providing residential care
$ 60.00 Annually
Business Member: An individual, organization, or business firm not owning, operating, or representing the interests of a residential care facility, but having related interests in the residential care industry.
$120.00 Annually
Total Due:$ (Note: Assisted living home owners are required to be members of the state TORCH organization, but business partners are not required to be state TORCH members.)

Submit Your Application

1525 Northland Street
Carrollton, TX 75006
Tel: 214-483-6671
Fax: 972-221-0627
Email: president@northtexastorch.com

North Texas TORCH (Texas Organization of Residential Care Homes) is a community of owners
and operators of residential care homes, personal care homes and assisted living facilities.
We promote a high quality of care, and a safe and comfortable environment for residential care
and assisted living residents in the state of Texas.

Home Name:
Number of Beds:
Owner:
Manager (if applicable):
Your First Name:
Your Last Name:
Address:
City:
State:
Zip:
Your Email:
Website Address:
Telephone:
Cell Phone (optional):
Fax:
Type:
Check all that apply:	Hospice
Check all that apply:	Respite
	Daycare
	Ambulatory
	Bedridden
	Wheelchair
	Oxygen
	Feeding Tube
	Incontinence
	Wake Staff at Night
TDHS License Number:
By submitting this Membership Application to TORCH, I agree to promote and implement the highest quality service and care to Residents of Residential, Assisted Living or Personal Care Homes.