Membership Application

Instructions

Please complete the membership application form.

IMPORTANT NOTE: While inputting your address, please select your country first. Once you have chosen your country, the state options will automatically update. You’ll then be able to select your state of residence from the list. Please contact Kim with any questions.

Select An Option

Student $35 Annually

Students currently enrolled in degree-seeking programs

Individual - Reduced Price $50 Annually

Individuals who are unemployed, are an early career professional, etc.

Retiree $75 Annually

Individual - Agency Member Employee $100 Annually

Individual membership for employees of current agency members of IPHA

Individual - Standard $150 Annually

Small Agency (<20 employees) $300 Annually

Includes 3 individual membership slots

Medium Agency (20-99 employees) $500 Annually

Includes 5 individual membership slots

Large Agency (100+ employees) $800 Annually

Includes 8 individual membership slots

Corporate $2500 Annually

Includes 10 individual membership slots

Enter Contact Information

Prefix (i.e. Mr. Mrs. Dr.)

First Name

Last Name

Suffix (i.e Jr. Sr. III)

Designations

E-mail

Family NameBusiness Name

Please select a valid membership option and fee item if exist

Membership Application

Support & Info

Main Office

Iowa Public Health Association

Iowa Immunizes is a program of the Iowa Public Health Association, focused on promoting vaccination education and advocacy.