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Questions marked with an asterisk (*) are mandatory.
Thank you for using our online application form. After completing the form you will be taken to a web page where you can pay your membership dues by credit card, PayPal or check. If you have any trouble with this form or the payment process, please email info@alaskapublichealth.org or call us at 907.450.2459.
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* Note any question with a * is considered mandatory and you will not be able to submit the form until you answer the question. Name:
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* Email Address (will be used for ALPHA correspondence only):
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Primary area(s) of practice (check all that apply):
| Alcohol, Tobacco and Other Drugs |
| Chiropractic Health Care |
| Community Health Planning and Policy Development |
| Community Health Worker |
| Disability |
| Environment |
| Epidemiology |
| Ethics |
| Food and Nutrition |
| Gerontological Health |
| Health Administration |
| Health Informatics Information Technology |
| Health Law Forum |
| HIV/AIDS |
| Injury Control and Emergency Health |
| International Health |
| Laboratory |
| Maternal and Child Health |
| Medical Care |
| Mental Health |
| Occupational Health and Safety |
| Oral Health |
| Podiatric Health |
| Population, Family Planning and Reproductive Health |
| Public Health Education and Health Promotion |
| Public Health Nursing |
| School Health Education and Services |
| Social Work |
| Statistics |
| Veterinary Public Health |
| Vision Care |
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Level of Membership:
| Individual ($55) |
| Student ($20) |
| Retired ($20) |
| Organizational Member ($125-$275 based on annual budget) |
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Organizational Membership. If you checked organizational member in the previous question, what is your organization's annual budget (or your best guess if you don't know precisely):
| Less than $250,000 ($125 membership fee) |
| $250,000 to $500,000 ($175 membership fee) |
| $500,001 to $999,999 ($225 membership fee) |
| $1 million or more ($275 membership fee) |
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Additional Contribution: Yes, I’d like to make an additional tax deductible contribution to ALPHA. These funds may be used to supplement travel scholarships for members to attend the summit, mini-grants to communities, or to support ALPHA’s mission.
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ALPHA is creating a password protected website for members to access one another. Is it okay for ALPHA to post your name and email address on the website’s members-only page?
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Is it okay to recognize your membership in our newsletter or website as a contributor/friend of public health?
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