Participant Registration for
the 2012 AAHB Scientific Meeting
Please complete all information requested below. When complete, click the "Continue" button. You will be given a choice of payment via check or credit card.
NOTE: If you are not a current AAHB member and wish to register as a Member, you must first apply for Membership. To do so, click here. Membership applications require TWO WEEKS for review. You may register as a non-member and once approved, the difference in fees will be credited to your account.
For more information, contact Joanne Sommers, Executive Director, The American Academy of Health Behavior, 17 Indian Creek Drive, Rudolph, Ohio, 43462, Phone number (419) 760-6020;
Email: jsommer@bgsu.edu
Participant Information
Participant First Name *:
Participant Last Name *:
Are you the participant or are you
completing this for someone else?
I am the Participant
I am completing this for someone else
If you are completing this for someone else, please fill in: Your Name:
Your Contact Phone #
Participant Position/Occupation *:
Organization *:
Type of Organization:
Address *:
Address 2:
City *:
State *:
Zip *:
Country *:
Phone Number *:
Email Address *:
Confirm Email Address *:
Name to appear on Name Tag *:
* Check here if this is your first time attending the AAHB Annual Scientific Meeting
