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Fill out the form below, and become part of our community.

Benefits of joining:

Engage and interact with other members
Become a thought leader
Be a part of making a difference

First Name is required.

First Name *

Last Name is required.

Last Name *

Please enter a valid date.

Date of Birth

Username is required.

Username *

(used to log in to the community)

Email Address is required.

Email Address *

Confirm Email is required.

Confirm Email *

Password is required.

Password *

Confirm Password is required.

Confirm Password *

Job Title is required.

Job Title *

Phone Number: is required.

Phone Number:

Facility Name (please do not abbreviate) is required.

Facility Name (please do not abbreviate) *

A complete address is required: Address 1, City, State/Province/Region, Postal Code and Country.

Facility (Main Address) *

Line 1

Line 2

City

State/Province/Region

Postal Code

Country

Please make at least one selection.

Certification or Quality Improvement Program *

Please select the Certification or Quality Improvement Program(s) your facility currently participates in.

AHA Staff (select if you are employed by the AHA/ASA)

Acute Stroke Ready Hospital

Advanced Certification Heart Failure

Calidad con Corazón Hospital Community

Comprehensive Cardiac Center Certification

Comprehensive Stroke Center

CPAHA - Tobacco Treatment

CPAHA - Telehealth

CPAHA - Telestroke

Diabetes Quality Collective

Equity-Focused Hypertension Initiative

Get With The Guidelines - Heart Failure Network

Healthy Senior Living Certification

Heart Attack Certification: Acute Heart Attack Ready

Heart Attack Certification: Comprehensive Heart Attack Center

Heart Attack Certification: Primary Heart Attack Center

Heart Valve Disease Education & Awareness

Home Health Heart Failure Certification

Hypertension Center Certification

Intracerebral Hemorrhage Network

International Chest Pain Certification

International Heart Failure A.S.I.A. Program

International Stroke Certification

Palliative/Hospice Heart Failure Certification

Post-Acute Care Stroke Community

Primary Stroke Center

Rural Community Network

Skilled Nursing Facility Certification

Telehealth Network Learning Lab

Thrombectomy - Capable Stroke Center

Not Applicable

Biography is required.

Biography

Please tell us about your experience and other relevant information.

Please make a selection.

Years of Experience

This field is required

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