Premium Monthly Membership

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 and pay, your application will be complete
2. Premium Monthly Membership is $29 per month, with a 12-month financial commitment
3. If canceled before the end of the term, the remaining balance is still due
4. Memberships auto-renew month-to-month after the initial 12 months unless canceled
5. No refunds will be issued for monthly payments under any circumstances
6. Submission can take up to a full minute. You do not need to click on SUBMIT more than once.

*Required Fields

Terms:

$29 / Month

First Name:* First Name Required

Last Name:* Last Name Required

Address:* Address is Required

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Phone number:* Phone number is Required

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Do you hold any of these certifications?

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

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

Did an APHA member refer you? Please give us their name so we can thank them!: Did an APHA member refer you? Please give us their name so we can thank them! is not valid

I understand this is a 12-month commitment with automatic monthly charges, that early cancellation does not waive the remaining balance, that my membership will auto-renew after the initial term, and that payments are non-refundable.*

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