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Umbra Associate – Founding Member

Umbra Associate Membership Application

Please complete the following application. Once we review your application and confirm your eligibility, we’ll send you all the information you need to get started.

Terms:

$399 / 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

Education: Education is not valid

Experience: Experience is not valid

Current APHA Membership:* Current APHA Membership is Required

I am currently a PACE or PACE International 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

Do you have professional liability / Errors and omissions insurance?:* Do you have professional liability / Errors and omissions insurance? is Required

Yes No

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

Username:* Invalid Username

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

Password Strength Password must be "Medium" or stronger

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You will see the full Premium price on the next page. Ignore it! We'll be doing discount math for you. Just click on the SUBMIT button on that invoice page for your Next Steps.

Existing Member

Existing Members will be manually approved for our new site. You'll receive a notice as quickly as possible that you have been approved, along with log-in information.

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