Renewal - Depricated - Association of Recovery in Higher Education: ARHE

Membership Type - Use the drop down menu to select your membership*

Institution Name/Business Name*

Member Name*

First Last

Member Email*

Member Phone*

Name of Person Filing Out Form

First Last

Is this membership being transferred to a different staff member upon renewal?*

No, the member listed above has been our delegate and will continue to represent the institution.
Yes, the member listed above is a transfer; they are not the individual who previously held the membership.
I'm not sure (you may be contacted for further follow-up).

Name of the Person on the original membership (the person who the membership is being transferred FROM)

First Last

Has the previous person left the institution?

Yes.
No, but they are no longer working with the collegiate recovery program.
No, they are still working with the collegiate recovery program but with to have the above member take over the member delegate role).

Address - must be credit card's address*

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

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

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Total

$0.00

Membership Renewal