AHHA GENERAL MEMBERSHIP APPLICATION


APPLICANT'S CONFIDENTIAL INFORMATION:
Full Name:
Organization:
Street Address:
City:
State:
Zip Code:
Country:
Work Phone:
Home Phone:
Cell Phone:
Email:
Website:
This contribution is from an individual a company
MEMBERS QUALIFY FOR VALUABLE DISCOUNTS AND BI-MONTHLY AHHA Members Only Newsletter

HELP AHHA GO GREEN:
There are two ways that you can help AHHA be more "green" and reduce our paper consumption:

Access some of your Thank You Packet online

Access the AHHA Members Only Newsletter online
Issues of the bi-monthly AHHA newsletter, published to promote networking among members, are posted in the online Members Only section

MESSAGE TO AHHA:
This area is provided to offer you an opportunity to send a special message to AHHA. Perhaps you wish to clarify something in this application. It would be interesting to know how you discovered AHHA.

CONTRIBUTION INFORMATION:
AHHA is a designated 501(C)(3) - Tax ID# 33-041271
Contributions are tax deductible as allowed by law


$ 30

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$

BASIC AHHA GENERAL MEMBERSHIP CONTRIBUTION
 I support the vital work of AHHA! The leading nonprofit wellness and healing information resource, valued by many of the foremost healthcare professionals in America.
$30 is my General Membership annual contribution

For foreign (non-USA) addresses - add an additional $10 toward extra postage costs

ADDITIONAL DONATION
 I understand that nonprofit AHHA remains free and impartial only through donations. In fact, AHHA's work is funded solely by contributions. Therefore, I want to contribute an additional amount to expand the outreach of this valuable organization.

Of the additional donation amounts over and above basic membership contribution, I select...
Platinum Circle = $500 or more
Gold Circle = $250 - $499
Silver Circle = $100 - $249
Bronze Circle = $50 - $99
Extra Gift = $49 or less

With permission of the donor, an extra donation over and above the basic membership contribution amount is acknowledged in the Honored Donors section of our website at ahha.org/donors.asp with the name of the donor. Gold and Platinum Circle level donors can add a hyperlink.
I grant permission to be added to the Honored Donors list

MY COMBINED SUPPORT TO AHHA
Type in the total amount you are contributing. This is the sum of basic $30 membership contribution, $10 towards foreign postage (if appropriate), and any additional donation.

SUBMITTAL OPTIONS:
(Option 1) To pay by check, money order or credit card by mail...
Click here for form to download form, printout, complete and mail in.

(Option 2) To pay by credit card using online Secure Server...
AHHA accepts Visa, MasterCard and Discover
  • Fill in ONLINE on this screen all information requested above
  • Print out a copy of all of the above for your records and as back up in case of error in information transfer.
  • Click on "Click here to Pay Online" button below
  • You will be transferred to the Authorize.net Secure Server
Once you have transferred to the secure server, you will be asked to...
Enter Credit Card Number and Expiration Date
Under "Customer Billing Information"
Enter Cardholder Name and Billing Address for Card
If you enter your email address, you will receive an immediate email notification of your transaction from the credit card operation.
AHHA will acknowledge your credit card transaction by notifying you of the authorization code.

Online Payment Service