Brevard Association of Human Services

Membership Application

In order to join Brevard Association of Human Services (BAHS) or Seminole Health & Human Services Networking (SHHSN), please completely fill out this form. You must select your membership level from the 3 levels of membership available, which are described in detail below. Once reviewed by BAHS you will be notified of your membership status.

Membership Levels Basic - Basic contact information is listed in the online membership directory. You also get to choose one category to be included in. Cost: Free Enhanced - Also includes 2 additional contacts, as well as 2 categories to be included in. Cost: $25/year. Premium - Also includes a website link, up to 4 additional phone numbers, 4 additional contacts, 3 categories to be included in, a company logo and picture, as well as a short description. Cost: $50/year.
Please make checks payable to BAHS and mail to: P.O. Box 964 Melbourne, FL 32902
* Required Field
Level:
Company	*
Category
Contact Information
First	*	Last	*
Address	*	City	*
State	*	Zip	*
Phone	*	Fax
General Level Information
Email
Premium Information
Cell		Other
Toll Free		Pager
Website
Description	characters remaining
Logo/Picture:	Please email your logo and pictures to members@bahsbuzz.org and it will be formatted and added to the site.