INDIVIDUAL MEMBERSHIP APPLICATION
Please enroll me as a member for one year in the category checked below.
Individual Membership: $150
Student Membership: $35 (Full-time students only, attach copy of valid student I.D.)
As a member benefit you may receive APHSA publications at no additional cost. Please select which of the following you wish to receive: Policy & Practice bimonthly magazine (please check which edition you prefer):
E-book electronic magazine (available through link on APHSA’s web site)
Print Edition
This Week In Washington (via e-mail, also accessible through the APHSA web site)
Electronic News Clipping Service (daily via e-mail)
Please send to this e-mail address:
COMPLETE ALL INFORMATION
Ms.
Mrs.
Mr.
Dr.
First/Last Name
Title
Agency/Organization
Business Address
City
Zip
Tel.
Fax
E-mail
Residential Address
City
State
State
Zip
Tel.
Fax
E-mail
Preferred mailing address
Business
Residential
PAYMENT INFORMATION
By clicking the submit button below you agree to pay APHSA the amount for the membership you selected in full, which will be charged to your credit card
in the following billing cycle.
APHSA Individual Membership Application - V1/2013
1133 Nineteenth Street, NW, Suite 400, Washington, DC 20036 | T 202.682.0100 | F202.408.5947 | www.aphsa.org | memberservice@aphsa.org
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