APHA Premium and Premium +ADL Membership Application

Congratulations on taking the next step in your patient advocacy journey!

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.

*Required Fields

Terms:

1 Year for $289 then $259 / 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:* Email 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*

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