Become a Member of Healthy Teen Network
Healthy Teen Network
Membership Application
Form Type


Membership Option

Organizational - Provides benefits for up to five individuals. Changes to organizational memberships must be made in writing.

Individual - Individual memberships are non-transferable.

Student - Documentation of full or part-time enrollment is required.

Organizational (1 year) - $450.00
Organizational (2 years) - $825.00
Organizational (3 years) - $1,150.00

Individual (1 year) - $150.00
Individual (2 years) - $275.00
Individual (3 years) - $395.00

Student (1 year) - $60.00


Personal Information











Organization Information

Please identify the most appropriate person in your organization to answer questions about your organization's programs and services? We are interested in learning more about our member organizations, but we are asking organizations to identify an organizational contact, so as to be more efficient and reduce the number of survey questions we ask all our members. This information will be used, with your permission, for the creation of an exclusive Member benefit, the Member Directory.

Organization Contact Name 
Organization Contact Email 






















Billing Information








Payment Information
Invoice
Credit Card