AHHA ORGANIZATIONAL 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 ORGANIZATION'S NAME:
Organization Name:
APPLYING ORGANIZATION'S CONFIDENTIAL CONTACT INFORMATION:
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
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 by mail...
Receipt
Certificate
Booklet

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

APPLICANT'S QUALIFYING CRITERIA:
To qualify as an AHHA Organizational Member your company/organization must:
  • offer a product, service, or educational opportunity that enhances health and well-being
  • encourage a holistic approach to creating wellness
List what health-related products, services, or educational opportunities your company/organization offers:
ORGANIZATION'S AUTHORIZED DATA FOR PUBLIC LISTING - shared with the general public:
The following information is authorized to be in the AHHA Organizational Member's listing shared with the general public in print and online.
Organization Name:
Street Address:
City:
State:
Zipcode:
Country:
Phone:
Email:
Website:
Descriptive Text:
Describe what types of products/services are offered; why someone would want them; how customers can obtain them. Space limits restrict this field to approximately 70 words or about 480 characters (dictated by printed version of list).

Listing Category:
Position our company/organization under the following heading on the networking list: *
MEMBERSHIP REQUEST:
Yes, our company/organization encourages a holistic approach to wellness, which encourages individuals to:
  • Make lifestyle choices that promote wellness
  • Participate actively in their health decisions and healing processes
  • Balance and integrate their physical, mental, emotional and spiritual aspects
  • Establish healthy and respectful relationships with others and the world around them.
Yes, our company/organization grants permission for release of the authorized information for the AHHA Organizational Member networking list and other public relations opportunities.

Yes, our company/organization wants to become an Organizational 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 Organizational 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/honored-donors 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:
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