Public Health Association of New york City

Individual Membership Application

If you are representing an organization, please use our Organizational Membership Application.

If you would prefer to mail this form, please download and print this PDF.

Contact Information
Name*
FirstLast
Degrees
Title(s)
Employer / School*
Address*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Work Phone*
Home Phone
(optional)
Fax
Email*
Membership Information
Type of application*
- New
- Renewal
Membership category*
Additional Donation
Total
$0.00
Use my contact information in the PHANYC membership roster*
- Yes
- No
APHA Member?*
- Yes
- No
How did you hear about PHANYC?
How would you like to receive communications?*
I am interested in serving on the following PHANYC committee(s)
- Policy & Legislation
- Program
- Membership
- Student
- Awards
- Nominating
- Communications
- Development
Payment Information
PHANYC accepts checks made out to PHANYC, or credit card payments through PayPal. If you pay by check, please forward your payment to PHANYC, 1710 First Avenue, Suite 282, New York, NY 10128.
For credit card payment, you will be asked to enter your credit card information using our secure online bill pay form through PayPal.
Note: Your membership will not be active until your payment is received.
Total
$0.00
Payment Method:*
- Check
- Credit Card / Paypal
Please make checks payable to PHANYC.
Mail to:
Public Health Association of New York City
1710 First Avenue
Suite 282
New York, NY 10128
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About PHANYC

The Public Health Association of New York City is an active organization of public health professionals with a rich tradition of commitment to improving public health.

Committed to promoting the health of the public, PHANYC confronts current public health issues by informing and mobilizing its members and the general public through community education and professional exchange, social action, advocacy and policy analysis.
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Upcoming Events
- June 28, 2013 9:00 AM –
  June 29, 2013 5:00 PM
  
  8th Annual Health Leadership "Aha!" Conference
- November 7, 2013 6:00 PM –
  November 7, 2013 9:00 PM
  
  Annual Event
View All Events