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Public Health Associate Institutional Membership Application

Questions?

Contact the Membership team: [email protected]

If your laboratory is a previous or current institutional member of APHL, please do not complete this form. Instead, please contact our Membership Department at [email protected].

Organization Information

Member-Representative

Member-Associates 

Please provide contact information for the laboratory’s appointed Member-Associates using the supplemental Member-Associates Contact Form. The amount of complimentary Member-Associate positions that your laboratory receives can be found in the dues section below. Additional positions can be purchased for $125 each.

DUES
Membership is based on a July 1 to June 30 year. *New members receive a 50% discount the first year.
Method of Payment

Once your application has been received and reviewed by the Membership Team, you will be contacted with instructions on how to submit your payment.

If you have any questions, please contact Drew Gaskins, Senior Membership Specialist, at 240‑485‑2733.

Member Associates Contact Form

Please list the contact information for your laboratory’s member-associates below. Member-associates are those laboratory staff chosen by the Laboratory Director to receive member benefits. Member-associates may not vote but have the right to hold appointed (but not elected) office (e.g., committee chair, liaison, task force), to serve on committees, and to speak from the floor of a general member meeting. The amount of complimentary Member-Associate positions that your laboratory receives can be found in the dues section on the previous page. The Laboratory Director may appoint additional member-associates for $125 each.

Member Representative #1

Member Representative #2

Member Representative #3

Member Representative #4