Association for Size Diversity and Health

Join ASDAH
Find HAES Expert
Join  
 Printer Friendly

ASDAH Membership Application

Individuals applying for membership agree to uphold the ASDAH Mission (view) and goals, and confirm their commitment to the Health At Every Size® Principles (view).

Membership Levels:
Full Membership - Dues $50  Open to any individual whose employment or volunteer work promotes or is moving toward the promotion of the Health At Every Size® Principles.  This level has full voting privileges.
Associate Membership - Dues $35  Available to non-professionals and professionals in fields unrelated to size diversity and/or health, who are interested in these issues.  This level does not have voting privileges.
Student Membership - Dues $20  Available to those interested in issues related to size diversity and health who show proof of full-time student status. This level does not have voting privileges.

The information that you provide on this membership application will be used only in our internal membership records and will be password-protected. To maximize the security of your account we ask that along with selecting a password you answer one of three "secret questions" as noted below.


Required *
Prefix  
First Name*  
Middle Initial  
Last Name*  
Membership Level*  
Degrees  
License/Certification  
Occupation  
Title/Organization  
Address (mailing)*  
Address (mailing - line 2)  
City *  
State/Province*  
(Add Option = NonUs.
Canada = drop down)
Zip/Postal Code*  
Country*  
Phone (primary)*  
(Please insert hyphens for all
phone #s, e.g. xxx-xxx-xxxx)
Phone (secondary)  
Fax  
Preferred Contact Method  
Email Phone
Preferred Email Format  
HTML Text
E-Mail (login ID)*  
Confirm E-Mail*  
Password*  
(password must contain at least one capital letter, one lowercase letter, one number and one special character and be at least 8 characters in length)
Confirm Password*  
Secret Question*  
Secret Answer*  
Join the ASDAH member email list?  
Yes No
Website  
How did you hear about ASDAH?  
Other HAES Affiliations/Organizations
(e.g. NAAFA)
 
If you would like to make an additional donation to support the work of ASDAH (over and above your membership fee) please complete the following two items:
Donation Amount   $
Donation Fund  
Donations to ASDAH support our effective and much-needed educational and advocacy efforts and are tremendously appreciated.

Note: ASDAH is a non-profit organization classified as 501 (c) (6). Contributions, gifts, and dues to ASDAH are not tax deductible. ASDAH donations & dues may be deductible as business expenses -- please consult your tax professional.
Email in Member Directory  
Yes No
Phone in Member Directory  
Yes No
Yahoo! Group  
Yes No
Are you interested in volunteering?  
Yes No
Comments/Questions  
Security Image*    Refresh

     
CAUTION: Please make sure this form is complete and accurate before selecting your payment option. Once you have clicked on Pay Online or Pay by Mail attempting to click your browser BACK button will result in an application error.


The Association for Size Diversity and Health welcomes people of all sizes and shapes regardless of race, color, national origin, religion, creed, gender, age, marital status, sexual/affectional orientation, mental or physical disability, or veteran status.
Promoting The Health At Every Size® Approach
©2014 ASDAH All Rights Reserved.

P.O. Box 3093 Redwood City CA 94064   ~   877-576-1102 (toll free)   ~   www.SizeDiversityandHealth.org