AHHA INSTITUTIONAL 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.

APPLYING INSTITUTION'S NAME:
Healing Center Name:
APPLYING HEALING CENTER'S CONFIDENTIAL CONTACT INFORMATION - for use by AHHA only:
This information is kept confidential, unless authorized elsewhere for inclusion in listing.
Contact Person Name/Title:
Contact Person Phone:
Contact Person Email:
Mail To Street Address:
Mail To City:
Mail To State:
Mail To Zipcode:
Mail To 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 an email with limited access.
Login-related email to use:

AHHA's GO GREEN options:
AHHA strives to go green and minimize our paper consumption
  • Your membership contribution receipt is emailed to you
  • 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 specific materials, we ask you to verify what you wish to receive...
  • To receive your certificate, suitable for framing, by mail you must check the following box
               Yes, mail our contact person our member certificate
  • To receive Wellness From Within: The First Step by mail you must check the following box
               Yes, mail our contact person one booklet

    Is your Mail To address outside of the U.S.? Then you need to prepay mailing costs of any materials sent to you.

    • QUALIFYING CRITERIA:
    To qualify as an AHHA Institutional Member your healing center must:
    • provide health care to individuals
    • provide alternative (complementary) therapies either exclusively, or integrated with conventional (allopathic) medicine
    • offer three or more modes of health care/modalities (such as, chiropractic, massage therapy and nutritional consulting or medical, acupuncture and psychotherapy)
    • have three or more health care practitioners on staff, who are fully trained and legally qualified to deliver the care offered
    • be a legally incorporated business entity (either for profit or nonprofit)
    • be located in North America
    Modalities Offered:
    List each healing modality offered by your healing center:
    Healthcare Staff:
    List full names of three key staff healthcare practitioners, who treat patients. Indicate which modalities each is trained and legally authorized to deliver:
    HEALING CENTER'S AUTHORIZED DATA FOR PUBLIC LISTING - shared with the general public:
    The following information is authorized to be in the AHHA Institutional Member's listing shared with the general public in print and online.
    Healing Center Name:
    Street Address:
    City:
    State:
    Zipcode:
    Country:

    Phone:
    Email:
    Website:
    Healthcare Approach:
    Patient Access:
    Treatment Therapies: Descriptive text listing treatment therapies available for patient care at Center (limit about 250 characters)
    Focus of Center: Descriptive text describing important, unique factors of what healing center offers, such as specific disease conditions treated, success rates, staff team approach, insurance coverage (limit about 250 characters)
    MEMBERSHIP REQUEST:
    Yes, our healing center grants permission for release of the authorized information for the Healing Centers in North America networking list and other public relations opportunities.

    Yes, our healing center wants to become an Institutional Member of the American Holistic Health Association and certifies that the information provided above is accurate.

    NOTE: For a legal equivalent of your signature in response to the above questions you must enter your full name and today's date in the Signature box below.
    SIGNATURE: (enter your full name and today's date)


    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
    $110

    FOREIGN POSTAGE
    $



    EXTRA
    $













    TOTAL
    $


    BASIC AHHA MEMBERSHIP CONTRIBUTION
    AHHA Institutional 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, we 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/donors.asp with the name of the donor. Gold and Platinum Circle level donors can add a hyperlink.
    We 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:

    Method will use to make membership contribution
    After you click on SUBMIT button, you are transferred to the payment information screen.
    Option #1 is to mail a check or money order to AHHA.
    Option #2 is to use your Visa, MasterCard, or DiscoverCard. For this there will be a button to transfer you to the Authorize.net secure website. Once there you enter the amount you are donating, then transfer to a form on the Authorize.net secure server where you enter your confidential credit card information.