ASSOCIATE MEMBERSHIP APPLICATION
Associate Membership Levels:
Associate: $3,000
Locals Associate: $5,000 (i.e., a State Association of Local Human Service Agencies, membership includes Locals Council communications, conference calls, and voting rights)
Premium Associate: Contact APHSA for details
COMPLETE ALL INFORMATION
Agency/Organization
Representative
Ms.
Mrs.
Mr.
Dr.
First/Last Name
Title
Primary Address
City
State
Zip
Tel.
Fax
E-mail
Company Web Site
As a benefit of Associate Membership, designated subscribers will receive APHSA’s electronic news clipping service, This Week in Washington, and e-mails on Capitol Hill actions, APHSA events, and other relevant resources. To receive these e-mails, please enter the recipiantnt’s e-mail address here (up to 5, separated by a comma): (Please note: changes to the subscriber list must be approved by the Company Representative)
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 Associate Membership Application - V1/2013
1133 Nineteenth Street, NW, Suite 400, Washington, DC 20036 | T 202.682.0100 | F 202.204.0071 | www.aphsa.org | memberservice@aphsa.org
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