New Member Application For Joint APHA/Affiliate Membership

* Denotes Required Field

First Name *

Last Name *

Middle Name

Organization

Degree

Position/Title

Business Telephone Number

Home Telephone Number (optional)

E-Mail Address *

FAX Number

Preferred Mailing Address *
Home Business (Select One)

APHA requests you use your home address so we can alert you to key votes being considered by the House Member and Senators who represent you.

Address 1

Line 2

City *

State or Province

Postal Code (Required for USA)

Country (if not USA) *
If you are located outside of the USA, your publications will be sent via air mail. There is an additional charge of $40 to cover the cost.

CHECK HERE	MEMBERSHIP TYPE	DUES
	Regular Membership Includes all member benefits including online access and monthly print issues of The Nation’s Health and the American Journal of Public Health.	$180.00/year
Special Subsidized Memberships
	Student: Full Time Persons enrolled full time (a minimum of 9 credit hours) in a college or university who are actively pursuing a degree in the health field. Proof of student status is needed. Please fax to 202-777-2530 or email to membership.mail@apha.org. Note, students automatically become members of the Student Assembly. Part time students, post doctoral candidates and others who cannot meet the above requirements may be eligible for the discounted Special Health Worker category.	$60.00/year
	Special Health Worker Membership Persons employed in community health whose annual salary is less than $40,000 or the equivalent for foreign nationals. (Please fax proof of status/income to: (202) 777-2530.) or email to membership.mail@apha.org.	$75.00/year

Select your affiliate*:

Your Primary Section is included in your dues.

APHA Section-1 (Free):**
APHA Section-2 ($30):
APHA Section-3 ($30):

Membership dues are not deductible as a charitable contribution but may be deductible as an ordinary and necessary business expense.
Membership is non transferable and non refundable.