AHHA GENERAL MEMBERSHIP APPLICATION


You can use the application form on this page to fill out and submit the application online
OR
You can download and printout an application form to fill out and mail in.

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:
Website:
MAIL TO ADDRESS:
Street Address:
City:
State:
Zipcode:
Country:

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


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's GO GREEN options:
AHHA strives to go green and minimize our paper consumption
Thank You Packet materials and bi-monthly member newsletter issues are accessed online in the Members Only Section
While we are happy to mail you your receipt and a booklet, we ask you to verify what you wish to receive by mail...
Receipt
Booklet

If your Mail To address is outside of the U.S., you need to prepay mailing costs of any materials sent to you.

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

FOREIGN POSTAGE
$



EXTRA
$













TOTAL
$


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


For non-U.S. addresses - add mailing costs for any requested mailed materials


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
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/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 mailing costs (if requested materials mailed to non-U.S. address), plus any additional donation you would like to make.

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:
After you click on SUBMIT button below, the data you entered above will be emailed to AHHA.
AND you will be transferred to the payment information screen.
Pick Option #1 to indicate you plan to mail a check or money order to AHHA to make your membership contribution.
Pick Option #2 to indicate you plan to use your credit card to make your membership contribution.
Method will use to make membership contribution