APHA Premium and Premium +ADL Membership Application

Once we receive your payment, your application will be complete. You’ll get all the information you need to access your new membership.

Not quite ready to fill this out?
Learn more about APHA Premium Membership.

Find the application form below.

Things to Know:

1. Once you submit this form, follow the prompts to pay. Once you pay, your application will be complete
2. A Premium / Premium +ADL membership costs $289 for the first year and $259 each year after that.
3. Your membership auto-renews unless you cancel before the renewal. You may cancel in your membership dashboard.
4. Submission can take up to a full minute. You do not need to click on SUBMIT more than once.

Before you fill out this form, see if you are entitled to an Affiliate Discount. If so, then you will be supplied with a different application link. It will look identical to this one! But the discount will be built in when you get to the Payment page.

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Terms:

1 Year for $289 then $259 / Year

First Name:* First Name Required

Last Name:* Last Name Required

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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

I have read and agree to the APHA Membership Terms Of Service*

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Password Strength  Password must be "Medium" or stronger

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