Organization Profile

Username *

Password *

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Organization

Organization Name *

Organizational Logo *

Maximum upload size: 16.78MB

Your organizational logo will appear on the IAPHS website (https://iaphs.org/join-iaphs/).

Website/URL *

Primary Contact Information

Please provide contact information for the individual IAPHS should contact about your organization and its IAPHS membership.

First Name *

Middle Name/Initial

Last Name *

Title *

Address *

Address

City

State/Province

Zip/Postal

Country

Email Address *

Phone Number *

Organization Data

Is Institutional Member Part of a Larger Institution?

Yes

Larger Institution

Training Levels

Undergraduate

Pre-doctoral (PhD, ScD, etc)

Professional (MD, Nursing, Pharmacy, Social Work, etc.)

Post-Doctoral

No / None of the Above

Social Media

Please provide the URLs for any social media platforms in which your organization participates.

Facebook

Twitter

SSRN

Population Health Activities and Interests

Please use up to 150 words to provide a brief statement about your organization's population health activities and interests.

Membership Directory

As a member benefit, the IAPHS website includes a membership directory. The following items will appear in the directory online:

Organization Name
Website/URL
Primary Contact Information
Training Levels

If you wish to 'opt out' from appearing in the directory, please indicate below. If you do not 'opt out', your information will appear online.

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Opt Out

Please opt our organization out of appearing in the online membership directory.

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