Membership

Join AzAIMH and get to know colleagues as passionate as you are about Infant Mental Health!
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Join AzAIMH

YES, I would like to become a member of the Arizona Association for Infant Mental Health (formerly the Infant Toddler Mental Health Coalition of Arizona) for $60.00 per year. (Membership Year: January to December.)

If paying by check, please complete this form, click the "Continue" button, print the form and include the printout with your payment.



Bolded fields must be completed for form to submit.
First Name
Last Name
Title
Address
City, ST  Zip  
PhonePlease include Area Code
FaxPlease include Area Code
Email
Alt. Email
Member Type
Pay ByCredit Card, or Check, or SMCC Grant (requires pre-approval)
Check box if interested in volunteering for the AzAIMH.

 

Your privacy is important to AzAIMH. To protect the information you provide, we have strict procedures in place to ensure that this information is not shared with any third parties and is only used for the purpose(s) for which you provide it. Membership information is only used to maintain accurate member records, notify members of upcoming AzAIMH events and AzAIMH-related events and notify members when renewal dues are due.

Wherever sensitive information (such as credit card numbers) is collected by us, it is encrypted and transmitted in a secure way. Third party processors (such as Stripe.com) also use encryption, but you should ensure the page you are on is a secure page before entering any information. You can ensure the page is encrypted by viewing the "https://" at the beginning of the address of the web page or looking for a "closed lock" icon on your browser's status bar.