Emeritus Membership By invitation only. Price: Free 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 Education: Education is not valid Briefly describe your relevant educational background. Experience: Experience is not valid Briefly describe your advocacy experience, paid or volunteer. Current APHA Membership: Current APHA Membership is not valid I am currently a PACE or PACE International Member I am currently a Premium member Which of the following organizations are you a member of, or participant in?: Which of the following organizations are you a member of, or participant in? is not valid CSA (Certified Senior Advisor) iRNPA National Institute of Whole Health WASHAA Assumption College Cleveland State None of the Above Why are you interested in advocacy as a career?: Why are you interested in advocacy as a career? is not valid Web Presence:* Web Presence is Required Liabiity Insurance:* Liabiity Insurance is Required Are you currently an APHA Member?: Are you currently an APHA Member? is not valid Do you hold any of these certifications? : Do you hold any of these certifications? is not valid 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) 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 Required 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 Do you have professional liability / Errors and omissions insurance?:* Do you have professional liability / Errors and omissions insurance? is Required Yes No Has there been a claim against you in the past seven years?:* Has there been a claim against you in the past seven years? is Required Yes No If Yes, please explain:: If Yes, please explain: is not valid Do you have knowledge or information of any act, error, or omission which might reasonably be expected to give rise to a claim against you?:* Do you have knowledge or information of any act, error, or omission which might reasonably be expected to give rise to a claim against you? is Required Yes No If Yes, please explain:: If Yes, please explain: is not valid Have you ever been turned down (declined) for Errors & Omissions or Professional Liability insurance?:* Have you ever been turned down (declined) for Errors & Omissions or Professional Liability insurance? is Required Yes No If Yes, please explain:: If Yes, please explain: is not valid Have you ever had Errors & Omissions or Professional Liability insurance that was canceled?:* Have you ever had Errors & Omissions or Professional Liability insurance that was canceled? is Required Yes No If Yes, please explain:: If Yes, please explain: is not valid Have you ever been the subject of disciplinary or investigative proceedings or reprimand by a governmental or administrative agency, hospital or professional association? :* Have you ever been the subject of disciplinary or investigative proceedings or reprimand by a governmental or administrative agency, hospital or professional association? is Required Yes No If Yes, please explain:: If Yes, please explain: is not valid Have you ever been convicted for an act committed in violation of any law or ordinance other than traffic offenses? :* Have you ever been convicted for an act committed in violation of any law or ordinance other than traffic offenses? is Required Yes No If Yes, please explain:: If Yes, please explain: is not valid Have you ever had any state professional license or license to prescribe or dispense narcotics refused, suspended, revoked, renewal refused or accepted only on special terms or ever voluntarily surrendered the same? :* Have you ever had any state professional license or license to prescribe or dispense narcotics refused, suspended, revoked, renewal refused or accepted only on special terms or ever voluntarily surrendered the same? is Required Yes No If Yes, please explain:: If Yes, please explain: is not valid What is your hourly rate?: What is your hourly rate? is not valid Username:* Invalid Username Email:* Invalid Email Password:* Invalid Password Password Confirmation:* Password Confirmation Doesn't Match Password Strength Password must be "Medium" or stronger I have read and agree to the APHA Membership Terms Of Service* No val Please fix the errors above
