AHA - 2008 Spring Conference Application

2008 Spring Conference Application

Are you a member of AHA who has joined or renewed membership on or after October 1, 2007? If you are not a member, please consider joining AHA now. Your membership entitles you to a substantial discount on all conferences and our newsletter among other benefits.

MEMBERSHIP STATUS

Check one of the following options for membership:

I am a current member of AHA

I am not an AHA member

I would like to join AHA and will include the membership fee with this conference registration payment.

For New OR Renewing Members:

I would like a one year membership @ $40.00

I would like a two year membership @ $70.00

Select a member type:

AHA provides many opportunities for volunteer work.
Can we contact you about volunteering for AHA? Yes No

For current members:
If you know your member number please enter it here:

REGISTRATION

* Includes FREE MP3 CD of all conference workshops if registration is completed by March 18, 2008. Free CD offer does not apply to students, individuals on the spectrum or Adelphi faculty. However, orders may be placed for CDs on this form or at the conference.
** Students must send a copy of their current student ID to AHA Association,
PO Box 916, Bethpage, NY 11714-0916.

WORKSHOPS YOU PLAN TO ATTEND

Workshop Period A Workshop Period B Workshop Period C

MP3 CDs ($50 each)

MP3 CDs of the entire conference, including all 12 workshops, are available for $50.00 each. Please indicate how many CDs you would like to order:
DO NOT INCLUDE FREE CD OFFERED WITH EARLY REGISTRATION

ATTENDEE INFORMATION

PLEASE COMPLETE A SEPARATE FORM FOR EACH INDIVIDUAL REGISTERING FOR THE CONFERENCE

First Name	Middle Last
Address 1
Address 2
City	State Zip Code
Country
Phone
Email

MAKE A DONATION

AHA IS 95% DEPENDENT ON MEMBERSHIP DOLLARS AND DONATIONS FOR ITS CONTINUED OPERATION. HELP US MAINTAIN THIS COMMUNITY ASSET.

I am making an additional donation to AHA of $

My total fee for this conference registration is $
(This amount includes membership fees and donations)

To complete this on-line registration you will be routed to PayPal.
PayPal accepts MasterCard, VISA, Discover and American Express, as well as the PayPal payment account. If you wish to pay by check please print our
brochure and send in the application form along with your check.
You may use your credit card with the mail-in form as well.
Remember: your registration is not complete until payment is received.

(please click button only once)

Questions? Email us at info@ahaNY.org or call us at 516.470.0360.