Join Public Health Liberation

Thank you for your interest in joining Public Health Liberation. This form is for either members of the following groups who cannot afford membership (HUD-assisted, Medicare, Medicaid, SNAP, and SSI recipients) or anyone with a financial hardship who cannot afford the first year of membership.

The regular membership link is available here. Completing this form does not make you an automatic member. The Board must review and approve all applications. You will receive an email from Public Health Liberation to verify if your application is approved.

Name

First Name

Last Name

Email

Address

City, State

The membership fee is $20. How much can you pay at this time?

Phone (Optional)

Organization (Optional)

Message (Optional)

Checkbox

I am either a member of an automatically exempt group (HUD-assisted, Medicare, Medicaid, SNAP, and SSI recipients) or have financial hardship and cannot afford the membership fee for the first year. Terms and Conditions Any corporate donations do not guarantee that Public Health Liberation will announce donations or otherwise allow for branding on our materials. These donations should be considered without any conditions (“unrestricted”). The membership fee is tax-deductible and non-refundable. The Board reserves the right to revoke membership at any time without issuing a membership refund if it deems a member is adversely affecting the interests, brand, or reputation of Public Health Liberation or any of its associated sponsors or allies. Members must receive written consent from the Public Health Liberation Board to use any copyright and trademark usage associated with Public Health Liberation, including but not limited to the logo, Public Health Liberation™, slides, recording, training materials, and other proprietary materials. Terms and Conditions Completing this form and making a payment does not make an applicant an automatic member. The Board must review and approve all membership applications and may ask for additional verification and documentation. If the Board does not approve your application, any payment will be returned. Membership applicants are only members once the Board has approved the application and the applicant is assigned a membership ID.

I agree