Membership Application

AHPNJ offers three unique membership opportunities:

$115/year General membership
$50/year Student membership
$275/year Corporate membership, which allows an organization to have two members and register any two staff members for AHPNJ events at the discounted member rate

After submitting your application, you will be prompted to complete payment by credit card via PayPal or you may mail a check instead. A PayPal account is not required.

Membership Type *

First Name *

Last Name *

Organization

Title

Address *

City *

State *

County

ZIP Code *

Email Address *

Website

Phone Number

Fax Number

Cell Number

Check areas of interest in AHPNJ: Committees Networking Seminars Accreditation

If you selected “Committees” above, tell us which specifically you are interested in: By-Laws/Ethics Education Finance Membership Nominating Policy Programs Publicity

Would you like to appear in the secure members-only member directory? Yes No

Would you like to appear in the public consultant directory? Yes No

Note that you may remove yourself from both the members-only member directory and the public consultant directory at any time.

Description of organization and services

Please describe your organization and the services you offer in a brief paragraph.

The fields below allow you to specify different information for the consultant directory. Leave these blank if you’d like to use your primary contact name, phone number, and email address.

Consultant Directory Contact Name

Consultant Directory Contact Email

Consultant Directory Contact Phone

AHPNJ Privacy Policy

AHPNJ will not share, rent or sell your email address to any other organizations or corporations. If you decide you want no further contact with AHPNJ, let us know at info@ahpnj.org.

AHPNJ thanks our sponsors for their generous support. View all of our sponsors »

Membership Application

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