subject_line
NHAHA Membership Registration Form
First Name
*
MI
Last Name
*
Gender
Title
*
Organization
Website
Address
*
City
*
Zip Code
*
State
*
Country
*
Business Phone
*
Fax Number
Email Address
*
Committee
*
Public Policy & Advocacy
Development & Finance
Program - Education
Program - Conference
Program - Capacity Building
Program - Research Tools
Region
*
US - Florida
US - Massachusetts
US - New-York
Canada
Haiti
Other
Select a Yearly Membership Dues
*
Individual: - Fee: $50
Organization: Up to $100,000 - Fee: $100
Organization: $100,000 - $500,000 - Fee: $150
Organization: $500,000 - $1 million - Fee: $250
Organization: $1 million and up - Fee: $500
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