MAHA: Discover MAHA: Join

Become a Member

Use this form to become a member of the MAHA community. Please fill out all of the provided fields.

Membership Fees:
Individuals

• $15 Introductory Membership

• $20 Regular Membership

• $35 Supporting Membership

• $50 Contributing Membership

• $100 Sponsoring Membership

Organizations: Membership is open to non-profit organizations that support MAHA’s goals.

• $50 Organizations with budgets less than $500,000

• $100 Organizations with budgets greater than $500,000

First name

Last name

Address

City

State

Zipcode

Phone (day)
ext:

Phone (evening)
ext:

Email

I am an individual applying for..
Introductory Membership ($15)
Regular Membership ($20)
Supporting Membership ($35)
Contributing Membership ($50)
Sponsoring Membership ($100)

I represent a non-profit organization applying for membership with a budget of..
less than $500,000 ($50)
greater than $500,000 ($100)

Credit Card Number:

MasterCard
Visa

Expires:

• $15	Introductory Membership
• $20	Regular Membership
• $35	Supporting Membership
• $50	Contributing Membership
• $100	Sponsoring Membership

• $50	Organizations with budgets less than $500,000
• $100	Organizations with budgets greater than $500,000

First name
Last name
Address
City
State
Zipcode
Phone (day) ext:
Phone (evening) ext:
Email
I am an individual applying for.. Introductory Membership ($15) Regular Membership ($20) Supporting Membership ($35) Contributing Membership ($50) Sponsoring Membership ($100) I represent a non-profit organization applying for membership with a budget of.. less than $500,000 ($50) greater than $500,000 ($100)
Credit Card Number: MasterCard Visa
Expires: