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GHSA Associate Membership Application

IMPORTANT INFORMATION: PLEASE READ BEFORE COMPLETING APPLICATION!
If you work for a State Highway Safety Office or existing GHSA Associate Member, you are already considered a member of GHSA.

GHSA Associate Members must agree to support the goals and objectives of GHSA and may not vote on Association policies. Associate Member dues support the general purposes of GHSA, including publications, training and research.

The GHSA Executive Board reviews all Associate Member applications quarterly. You will be notified after the next Board Meeting whether your application has been accepted. Associate Membership does not imply GHSA endorsement or grant permission to use the GHSA logo.

Select Associate Membership Price *

DUES PAYMENT
GHSA bylaws specify that Associate Member dues be assessed at the time of application. If paying by check, please mail your payment to:

GHSA Associate Member Dues
660 North Capitol Street NW, Suite 220
Washington, D.C. 20001-1642
 
If paying by credit card, please call Mary Beth Lord at 202-580-7932 to provide your credit card information.

If your application is rejected, your dues payment will be refunded.

Organizational Information

Which of the following categories best describes your organization? Please select ONE of following options below. If you believe your organization falls under more than one category or under a different category not listed, please email Stephanie Nguyen at snguyen@ghsa.org for further assistance. *

Primary Contact Information

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Web Listing

GHSA maintains a web page with the logos and descriptions of all our Associate Members.

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