ASPHN New Member Application Form

ASPHN New Member Application Form

Welcome and thank you for your interest in ASPHN!
Our updated membership application has been designed to take the guesswork out of which membership category applies to you.

By answering the brief “yes” or “no” questions below, the application will lead you to the membership category that best aligns with your work. Have questions while answering? Reach out to Allison McGuigan at allison@asphn.org.

If a membership fee is applicable, your payment will be securely processed at the end of this form via PayPal. You also have the option to pay with a debit or credit card via PayPal if you would prefer not using a PayPal account.

If you would like more information about our membership categories and annual dues before starting your application, please visit our Membership webpage.
Which one of the following statements best describes your employment situation:

Other

Your Membership Category: General Member

If your state agency or organization already pays annual dues, then there are no costs incurred by you. Your application will be processed upon submission.

If you are unsure if your state agency or organization has paid dues, reach out to Allison McGuigan at allison@asphn.org.
Your Membership Category: Associate Member

Dues are $50.00 per person/year. If an organization has several people who want to join ASPHN, the organization can pay the dues for the group and the cost is $50 per person. If the organization has 9 to 50 people interested in joining the dues are a maximum of $400 for the year. Contact Allison McGuigan (allison@asphn.org) if you have questions.

Dues can be paid via credit or debit card or PayPal as the last step of this application process.

From July thru December, new members can join for $25.00 through the end of the calendar year. In January of the following year, you will receive an invoice for $50.00 for dues for the next calendar year.

Applications will be processed when payment is received.
Your Membership Category: Emerging Professional

Dues are $25.00/year and can be paid via credit or debit card or PayPal as the last step of this application process. Applications will be processed when payment is received.
Your Membership Category: Retired Professional

Dues are $25.00/year and can be paid via credit or debit card or PayPal as the last step of this application process. Applications will be processed when payment is received.
It would seem none of the above questions apply to you or we were unable to determine your Membership category.
Select the membership category for which you are eligible. Eligibility is based on your employment or professional status, not membership cost.
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Associate Member
$25



Retired Professional

$25



Emerging Professional
$25



General Member
Available only to employees of state health agencies.

Free



Total

$0.00
If you have any questions, please reach out to Allison McGuigan at allison@asphn.org for assistance.
Name

First NameLast Name
Credentials
Organization / Institution Name / School
Job Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
Phone Number

Area CodePhone Number
Extension
Please upload a photo (.jpg format) to be posted in the ASPHN member directory on our website.

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Please select the ASPHN Councils, Committees, and programs you are interested in learning more about and participating in:
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ASPHN New Member Application Form

Your Membership Category: General Member

Your Membership Category: Associate Member

Your Membership Category: Emerging Professional

Your Membership Category: Retired Professional

Select the membership category for which you are eligible. Eligibility is based on your employment or professional status, not membership cost.*

Select the membership category for which you are eligible. Eligibility is based on your employment or professional status, not membership cost.