New Member Application Form

* Denotes Required Information

Last Name *
First Name *
Middle Name
E-Mail Address *
Degree
Position/Title
Organization
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.		 Ln 1:
Ln 2:
City *
State or Province
Postal Code *
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.
Business Telephone Number
FAX Number
Home Telephone Number (optional)
How did you hear about us? *
If referred to APHA by a friend, co-worker or
APHA member, please tell us who.
Did you receive a promotional mailing from APHA?
If so, please enter the promotional code here:

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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.		 $195.00/year
Contributing Membership
Open to health professionals, other career workers in the health field and any persons interested in public health; includes extra benefits and recognition at the Annual Meeting. 		$250.00/year
The following are our 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 mail it to APHA. Note, students automatically become members of the Student Assembly.

Students wishing a print copy of AJPH, in addition to the online access, may choose to pay $30.00 for this add-on benefit.
Check this box if you would like to order to purchase this additional benefit.

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 to: (202) 777-2530.) 		$80.00/year
Retired Membership
APHA members who have retired from active public practice and no longer derive significant income from work-related activities. (Retired members will receive a print copy of the American Journal of Public Health.) 		$80.00/year
Consumer Membership
Persons who do not derive income from health-related activities. 		$80.00/year

Additional Section/SPIG Options       Click here for more information

Section/SPIG -1 (Free)**:
Section/SPIG -2 ($30):
Section/SPIG -3 ($30):
*Membership dues are not deductible as a charitable contribution but may be deductible as an ordinary and necessary business expense
**Your Primary Section #1 is included in your dues
  





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