AHHA GENERAL MEMBERSHIP APPLICATION


GENERAL MEMBERS QUALIFY FOR DISCOUNTS, 2 EDUCATIONAL VIDEO LISTINGS,
1 FACEBOOK POSTING, AND BI-MONTHLY AHHA Members Only Newsletter

You can use the online renewal form on this page to fill out and submit AND then access Authorize.net or PayPal for an online credit card transaction OR then mail a check or money order to AHHA.
OR
You can download and printout an application form to fill out and mail with check or money order to AHHA.

APPLICANT'S CONFIDENTIAL INFORMATION - for use by AHHA only:
This contribution is from an individual a company
Full Name:
Organization:
Work Phone:
Home Phone:
Cell Phone:
Email (REQUIRED):
Website:
Mail To Address:
Street Address:
City:
State:
Zipcode:
Country:

MEMBER LOGIN:
Each AHHA membership has a login/password for access to the online AHHA Members Only Section. Designate an email that can be used in case you forget your password in the future. It is best to use a personal email.
Login-related email to use:

AHHA IS PAPERLESS
Your AHHA membership contribution receipt is emailed to you.
The bi-monthly member newsletter issues are accessed online in the password-protected Members Only Section.


MESSAGE TO AHHA:
This area is provided to offer you an opportunity to send a special message to AHHA.

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

BASIC
$30


EXTRA
$


















TOTAL
$


BASIC AHHA MEMBERSHIP CONTRIBUTION
AHHA General Membership contribution for the next 12 months


ADDITIONAL DONATION
Contributing an additional amount to expand the outreach of this valuable organization
Over and above the basic contribution above, I donate an additional donation amount
Platinum Circle = $500 or more
Gold Circle = $250 - $499
Silver Circle = $100 - $249
Bronze Circle = $50 - $99
Copper Circle = 45 - $49

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/honored-donors 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


COMBINED SUPPORT TO AHHA
Type in the TOTAL AMOUNT you intend to contribute to AHHA.
This is the SUM of basic membership contribution, plus any additional donation you would like to make.

We strongly recommend that you print out a copy of all of the above for your records, as back up in case of a technical glitch in information transfer.

SUBMIT APPLICATION INFORMATION TO AHHA:

IMPORTANT: THIS FORM DOES NOT MAKE YOUR PAYMENT.
BELOW YOU INDICATE WHICH OPTION YOU WILL USE TO MAKE YOUR CONTRIBUTION.
 Select one from the following menu:
Pick Option #1 to indicate you plan to use your credit card to make your membership contribution.
Pick Option #2 to indicate you plan to mail a check or money order to AHHA to make your membership contribution.
Method will use to make membership contribution

Now click on SUBMIT button below so that the data you entered above is emailed to AHHA.
After you hit the SUBMIT button, you will be transferred to a new page with links to secure payment options by credit card.