Join HAEA
Interest Survey
As we continue to grow together, we want to always be sure that we are meeting the needs of you, our HAEA members. Through a more focused approach to Health, Advocacy, Engagement and Advances in Research (HAEA,) we hope to serve you better. In order to do this, we ask that you please take a moment to answer the following brief survey and update your personal information. We are committed to our HAEA community and look forward to helping you achieve lifelong health.

1. What is your relationship to the HAEA? 






2. How would you like to be contacted? Please check ALL that apply:  





3. How many times per month may we contact you? 





4. What topics interest you? Please check ALL that apply 






























5. How can we reach you on Social Media 
Facebook:

Twitter:

Instagram:

Snapchat:


*Please update the following information so that we can communicate better with you.

First Name: 
Last Name: 
 
Address: 
 
 
City: 
State:    
Zip Code: 
 
*E-mail address: 
Home Phone: 
Cell Phone: