Membership Registration

Fill out the form below to become a member of FAAHPN. Please note that the registration process will be complete when the payment has been submitted online or mailed in to FAAHPN.

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Membership Status *

• New Member
• Membership Renewal

Name *

Institution/Business Name

receive Membership Options

Email *

Address

City, State, Zip Code *

Primary Phone

How would you like to receive the FAAHPN newsletter?

• E-mail
• US Mail

Membership Sector--- Select Choice ---ArtHistoryScienceOther

Membership Options *--- Select Choice ---Individual Member - $25Level 1 Institutional Member - $50 (Annual Budget: $0 – $50,000)Level 2 Institutional Member - $75 (Annual Budget: $50,001 – $100,000)Level 3 Institutional Member - $100 (Annual Budget: $100,001 – $250,000)Level 4 Institutional Member - $150 (Annual Budget: $250,001 – $500,000)Level 5 Institutional Member - $200 (Annual Budget: $500,001 – $1,000,000)Level 6 Institutional Member - $250 (Annual Budget: Over $1,000,000)Level A1 Affiliate Member - $125 (1 representative may attend the annual conference at member fee)Level A2 Affiliate Member - $250 (2 representatives may attend the annual conference at member fee)Level A3 Affiliate Member - $500 (3 representatives may attend the annual conference at member fee)

Member Knowledge, Skills and Abilities (select all that apply)

• Administration, Operations and Governance
• Board Training and Development
• Collections Management/Curatorial Issues

Electronic Signature *

Date (mm/dd/yyyy) *

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