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GHSA Associate Membership Application - Credit Card Payment ONLY

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 (March, June, August, December). 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.

*To be considered at GHSA's Executive Board Meeting in December 2020, please complete your application and provide payment by November 20, 2020.*

Select Associate Membership Price *

Payment

Please select the payment method your organization plans on providing for membership dues. GHSA bylaws specify that Associate Member dues be assessed at the time of application. Your organization's application will not be considered for Board approval until payment is received. If your organization only provides check payments, please contact Denise Alston at dalston@ghsa.org or 202-580-7929 for more directions. *
DUES PAYMENT
For any financial questions or concerns, please contact Denise Alston at dalston@ghsa.org or 202-580-7929.

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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