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Membership Application
Name: ________________________________________________________________________________
Organization: ___________________________________________________________________________
Address: ______________________________________________________________________________
City: __________________________________ State: ________ Zip code: __________________________
Phone: __________________________ Home or Work (circle one) Fax: ____________________________
E-Mail: __________________________________ Homepage: ___________________________________
All membership categories entitle the member to a full range of benefits listed in the membership brochure, including reduction in conference fees for one person.
__________Individual Membership ($50)
__________Non-Profit Agency or Government Organization ($100)
__________For Profit Organization ($150)
__________Please check here if you do NOT want your name, address, and phone number published in the member directory.
Organizational Memberships include the benefit of web site linkage from the AAHC web site (www.aahc.info). Please indicate if you wish this connection: Yes _________ No _________
If Yes, please include identifying information and logo to be used: ________________________________________________________________
If you are an organizational member, please list full name of the contact person, phone number, and E-mail address, if different.
Please print this page and return with check or money order to:
AAHC
PO Box 36494
Phoenix, AZ 85067-6494
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est. 1989, incorporated 1996