GENERAL INFORMATION First Name (required) Middle Name Last Name (required) Preferred Mailing Address HomeBusiness
Your Email (required) Date of Birth (required) GenderMaleFemale
Area of Expertise (required) Years of Experience in Primary Field(s) of Expertise (required)(0-4)(5-9)(10-14)(15+) If Business owner, please check here:
REASON FOR JOINING AHP (Check all that apply) Social/Professional NetworkingCareer enhancement/Professional DevelopmentKeeping up with happenings in Haitian communityAll of the AboveOther
HOW DID YOU HEAR ABOUT AHP? (required) AdvertisementAHP BrochureInternetOther Professional Organization AHP Member or Other
COMMENTS How would you like to be contacted in reference to your comments above? EmailPhone
Please read this carefully before checking: *** (Required) All the information I have provided in this application form is accurate. I have reviewed the material on AHP's mission, strategic objectives, vision and values and will be actively involved in advancing them.
A confirmation notice will be sent once the form has been submitted. We will review it and if approved, you will receive instructions to process with step 2, which is Payment. If not approved, you will also receive a notice with further necessary requirements. Membership enrollment is effective for one calendar year from payment processing date.
