Aging Life Care Association Application Affiliate Terms: $199 / Year First Name:* First Name Required Last Name:* Last Name Required Address:* Address is Required City:* City is Required State or Province:* State or Province is Required Zip or Postal Code:* Zip or Postal Code is Required Country: Country is not valid USA Canada Other Country (Outside US and Canada): Country (Outside US and Canada) is not valid Phone number:* Phone number is Required Email (to match for renewal):* Email (to match for renewal) is Required Do you hold any of these certifications?:* Do you hold any of these certifications? is Required Board-Certified Patient Advocate (BCPA) Certified Senior Advisor (CSA) Certified Life Care Planner (CLCP) Certified Geriatric Care Manager (CGCM) Certified Medical Coder (CMC) Certified Case Manager (CCM) Social Worker (LCSW, MSW) Registered Nurse (RN) Certified Nurse Practitioner (CNP) Physicians Assistant (PA) Medical Doctor (MD) Pharmacist (PharmD) Occupational Therapist (OT) Physical Therapist (PT) Chiropractor (DC) Medical Assistant (CMA) Certified Nurse Assistant (CNA) Other None of the Above Where did you hear about the Alliance of Professional Health Advocates?: Where did you hear about the Alliance of Professional Health Advocates? is not valid Your experience (Please check all that apply):* Your experience (Please check all that apply) is Required I have worked in a healthcare administrative role I have worked in a healthcare clinical role I have been an unpaid caregiver I have been a non-clinical paid caregiver I have had training in patient advocacy/care management/care coordination None of the above Are you a current ALCA member?:* Are you a current ALCA member? is Required Yes No I have read and agree to the APHA Membership Terms Of Service* Email:* Invalid Email Password:* Invalid Password Password Confirmation:* Password Confirmation Doesn't Match Password Strength Password must be "Medium" or stronger Have a coupon? Coupon Code: Invalid Coupon Coupon applied successfully No val Please fix the errors above
