membership renewal

Contact Information

First Name (Required)

Last Name (Required)

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Organization

Job Title

Discipline

Address Name (Required)

Address (Line 1)

Address (Line 2)

City

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 membership is from March of 2017 as part of AVA's conversion to an annual renewal cycle where all members renew their memberships in March of each year, you must log in. If you do not know your member login ID and password, please contact info@avahealth.org. All AVA memberships will run from March to March following the current conversion process.

Your total payment will be