Join - Association of Recovery in Higher Education: ARHE

Membership Enrollment Form

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Quantity*

Is this membership enrollment for an Institutional Membership?*

Institutional Memberships must be institutions of higher education

Is this membership enrollment for an Organization Membership?*

Individual Membership Type*

For Student and Associate Memberships please list your personal email and personal information. This is an individual membership that belongs to you as a student or individual, not attached to the school or work you attend. Renewals invoices will be sent to your personal email. Individual membership are not transferrable.

Classification of Institutional Membership*

Organizational Membership*

The Institutional Contact

Is a person that is used as an alternate contact when we can not get in touch with the membership delegate. The member delegate as listed below is the person that is entitled to the benfefit of an Institutional membership. The contact and member delegate can be the same

Do you work for / attend an institution with a collegiate recovery program?*

Yes
In Development
No
I'm not sure

Name*

First Last

Job Title*

Email*

Phone*

Institution/Organization Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Designated Professional Affiliate Member Information

(This is the person that will be the member delegate for the Institution and will carry the membership benefit)

Affiliate Name*

First Last

Affiliate Email*

Affiliate Phone*

Affiliate Job TItle*

Affiliate Website*

Payment

Payment Method: Credit Card, Check, PO or Grant*

Check or PO - Invoices will be sent to the enrollee for payment instructions. Payment Method by Grant: Please notify ARHE that your enrollment form has been completed

Total

$0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Join ARHE Today!

Membership Enrollment Form

The Institutional Contact

Designated Professional Affiliate Member Information

Payment

COLLEGIATE RECOVERY PROGRAM

COLLEGIATE RECOVERY PROGRAM

COLLEGIATE RECOVERY PROGRAM