AHA Membership Form
Please select if you are a new member or are renewing *
(Membership cycle is based on the calendar year, January to December)
Please select a membership category *
Name (Last name, First name) *
Institution/Position *
Mailing Address *
Example format: 123 Address St. Honolulu, HI
Email *
Phone number (Work) *
Example format: 808-123-4567
Phone number (Personal) *
Example format: 808-123-4567
I would like to be included in the AHA Member Directory *
I will pay my membership dues
Clear selection
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