APPLICATION FOR MEMBERSHIP
ALABAMA RURAL HEALTH ASSOCIATION
(Print and complete this form and return to the address given below)
Name: ___________________________________________________
Organization: ______________________________________________
Address: _________________________________________________
Address: _________________________________________________
City:_______________________ State: _______ Zip Code: _________
E-mail Address: ____________________________________________
Telephone Number: ( ) ____________________________________
Facsimile Number: ( ) _____________________________________
Specify Type of Membership:
( ) Individual Membership ($20.00)
( ) Student Membership ($10.00)
( ) Organizational Membership ($150.00)
( ) Sponsorship ($400.00 or more)
Return completed application to:
Alabama Rural Health Association
Post Office Box 640308
Pike Road, Alabama 36064-0308
Make your check payable to Alabama Rural Health Association.
Members, Only Mission/History Join ARHA Officers/Committees Publications/Studies
Statistics Rural Health Grants Announcements Training Legislation ARHA Calendar
What is Rural? NRHA Alerts Awards/Success Stories Links
Rural Health Classifieds Contact ARHA