Online Member Application

Only complete this form if paying with a credit card. A paper application should be completed if submitting a check. Application Type:* New Renewal   Prefix:* Choose Option Mr. Mrs. Ms. Dr.   First Name:*   Middle Name:   Last Name:*   Accreditation: (CFRE, FAHP, etc.)   Title:*   Organization:*   Address1:*   Address2:   City:*   State:*   Zip:*   Phone:*   Mobile:   Fax:   Email:*   Are you a member of the Association for Healthcare Philanthropy (AHP)?* Yes No   Type of organization:* (choose best option) Choose Option Academic Medical Center Affiliated Health Organization Community Hospital Hospice Long-Term Care Facility Specialty Hospital Resource Provider Visiting Nurse Association (VNA) Other   Area(s) of expertise to share with other members:* (check all that apply)   Accreditation Yes   Annual Giving Yes   Board Development Yes   Capital Campaigns Yes   Consultant Yes   Corporate Giving Yes   Database Management Yes   Direct Mail Yes   Donor Relations Yes   Employee Giving Yes   Government Relations Yes   Grants Yes   Information Systems Yes   Internet Fundraising Yes   Major Gifts Yes   Management Yes   Membership Yes   Physician Giving Yes   Planned Giving Yes   Prospect Research Yes   Public Relations Yes   Recognition Yes   Small Shop Yes   Special Events Yes   Volunteer Groups Yes   Who is paying for your membership?* I am paying personally. My organization is paying.   Annual Dues: $125       Finished? Click "Submit Application" to proceed with credit card payment.     (If paid by the organization, the membership will remain with the organization if you leave.)

 

NEAHP • 411 Waverley Oaks Road, Suite 331B • Waltham, MA 02452
Phone: (781) 647-7004 • Fax: (781) 647-7222
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