membership renewal

Contact Information

First Name (Required)

Last Name (Required)

Organization

Job Title

Discipline

Address Name (Required)

Address (Line 1)

Address (Line 2)

City

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State

Zip Code

E-mail Address (Required)

Phone(provide cell phone for text communications)

Membership Eligibility

I possess a current and valid professional license (if applicable), am in good standing in my other professional societies or organizations and am committed to the Academy’s Mission and Vision.

Additional Details

Membership Options

Active Membership ($100)
Student Membership ($25)

Credit Card Information

Cardholder Name (Required)

Credit Card # (Required)

Visa MasterCard American Express Discover

Expiration Date (Required)

Security Code (Required)

Visa®, MasterCard® & Discover® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

American Express® cardholders
Your security code is the 4-digit code located above the actual credit card number on your card's front.

Billing Zip Code (Required)

AVA's membership cycle begins in March of each year. You must log in to renew your membership. If you do not know your member login ID and password, please contact info@avahealth.org

Your payment will be