Membership Category A - Direct Services Provider

Organization Name

Name

First Name

Last Name

Title

Organization Address

Phone

(###)

###

####

Website

http://

Names/Emails of others from Your Organization to Receive ABHA Communications

Organizational Budget/Dues

Less than $500,000 / $650

$500,001 - $999,999 / $1,350

$1,000,000 - $2,999,999 / $2,000

$3,000,000 and greater / $5,000

Organization Overview

Please provide a short description of your organization and the services provided so we can better meet your needs, and let us know what you hope to gain with membership in the Association.

Process to Join

Complete this application.

The prospective member’s application form is reviewed with the ABHA Board for approval.

Once approved, the organization submits payment to initiate membership onboarding.

Membership Category A - Direct Services Provider

Process to Join

ALASKA BEHAVIORAL HEALTH ASSOCIATION