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Associate Membership Application

Thank you for your interest in completing an Associate Membership application. Please take your time in completing the application, including the Certifications and Representations section.

MHA staff will contact the primary point of contact on the application regarding next steps once a complete review of the application has occurred.

Note:

  • If your application is approved between Jan. 1 and Aug. 31, your associate status will be predated to Jan. 1 of the same year.

  • If approval occurs after Sept. 1 your membership will be valid through the next calendar year.

Contact Information

Membership Representatives

Information About Your Organization

If application is approved, MHA will require an appropriate high-resolution logo, link, and will pull from your provided description for website content.

Certifications and Representations

Associate members must subscribe to MHA's mission, which promotes mental health as a critical part of overall wellness, including prevention services for all, early identification and intervention for those at risk, integrated care and treatment for those who need it--with recovery as the goal.

You will be able to submit payment information after completing this form.

Submitter Information

500 Montgomery Street, Suite 820
 Alexandria, VA 22314

Phone (703) 684.7722

Toll Free (800) 969.6642

Fax (703) 684.5968

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