Membership

Online Membership Form

This form is for new or renewing members who wish to pay dues using Paypal (an online payment processor that offers credit card payment among its options).  If you prefer to send payment through the mail, please use the mail-in membership form instead.

  • For technical problems with this form, please .
  • If you have a non-technical problem related to initiating or renewing membership, please .

WHEN YOU HAVE COMPLETED THE FORM, CLICK THE SUBMIT BUTTON TO SEND THE DATA.  YOU WILL THEN PAY YOUR DUES THROUGH PAYPAL.  

Your Name
Name (if different) to appear in Membership Directory
Name of institution or business if applicable

Street Address
City State Zip+4 Code

Country
Email address
Telephone

New or Renewing Member

 

Type of Membership

 

Membership Dues

AHPCS is a not-for-profit, [501 C-3 Federally Tax exempt organization and any contribution 
above the regular dues is tax-deductible.  Below are the various membership levels we offer.  You may pay for one or two years.
    

 One YearTwo Years
  Regular $ 50 $ 90
  Contributing $ 65 $ 117
  Overseas $ 65 $ 120
  Patron $ 100 $ 180
  Benefactor $ 125 $ 225
  Life $1000  

Please select the level and length of membership you desire.

  

Interests

For the AHPCS Directory, describe your personal interests or specialties (in thirty words or less) 
OR use the check boxes below.

  

DO NOT USE IF YOU PROVIDED A DESCRIPTION ABOVE.
Select as many as desired. To choose more than one category, press the control key while clicking on your categories.

  

   Other