Membership Registration

MEMBERSHIP

Membership Registration

You may fill out the Membership Registration form below and make your payment through PayPal or download the pdf form (click here), fill it out and send it to us by post (please follow the instructions on the pdf form).

REGISTRATION INFORMATION

*Required Field

*First Name:
*Last Name:
*Registration Year:
Job Title:
Company/Institution:
*Phone:
Alternate Phone:
*Email Address:
Website:

MAILING ADDRESS

*Country

United States Canada Mexico

*DO YOU WANT YOUR NAME TO APPEAR IN THE MEMBERSHIP DIRECTORY?

Yes No

If your answer to the above question is yes, please provide current projects or interests (25 words or less) for the Membership Directory.

MEMBERSHIP DUES

Note: Annual dues correspond to the calendar year, January 1^st through December 31^st

*Select annual dues:

Regular Dues $45 (USD/CAD)

Family Dues $75 (USD/CAD) Includes two (2) members at one address and one copy of the newsletter

Student Dues $15 (USD/CAD) Student ID is required; upon submission of this form, please scan and email a copy of your id to astrid.liverman@gmail.com

Institutional/Company Membership $95 (USD/CAD) Includes up to three (3) members from one organization.

DONATION

I would like to donate to the AHLP Student Scholarship Fund (supports student participation in annual conference)

Yes No

Anti-Spam Protection

You may choose to pay in either American or Canadian funds. Please select a PayPal link below or click the reset button to reset the form.

*Street Address:
*City:
*Select a State:
*Zip Code:

*Street Address:
*City:
*Select a Prov/Territory:
*Postal Code:

*Address 1 / Calle y No. Ext.:
*Address 2 / Colonia:
*City / Ciudad:
*Province / Territory / State / Delegacion:
*Postal Code / Zip Code / Codigo Postal:

*Street Address:
*City:
*Select a State:
*Zip Code:

*Street Address:
*City:
*Select a Prov/Territory:
*Postal Code:

*Address 1 / Calle:
*Address 2 / Colonia:
*City / Ciudad:
*Province / Territory / State / Delegacion:
*Postal Code / Zip Code / Codigo Postal: