We are currently signing people up for the Genomics Forum. If you are an APHA member, and have not already done so, please also enroll through the APHA website.

The only required fields are name and APHA section or SPIG (if applicable). However, we appreciate any additional information that you provide so that we can best serve the needs and interests of our members.

Please remember to click on the "Become Member" button at the bottom of the page to submit your information.

If you prefer, you can also download a signup form.

If you have trouble using this form, please email us.

Website Username*	* required. This username is already taken
Password*	* required.
Confirm Password*	The passwords don't match.
First Name*	* required.
Last Name *	* required.
Email *	* not a valid email address. * email is required. * You have already registered.
APHA Section or SPIG * (* required)	* required.
Organization
Title
Website
Contact Information: Full Address	line 1: line 2: line 3: city state zip/postal , country:
Work Phone #
Which best describes your organization?
Describe your organization
Describe your main areas of interest in genomics and/or Public Health
Would you be willing to serve as a press contact? (check box for yes)	(a Press Contact would be a person who, upon request, would offer input based off of their area of expertise for publications and other media sources.)
Would you be willing to serve as a speaker/lecturer? (check box for yes)
Area(s) of Expertise
What needs could the forum fill for you? (e.g. education, networking, etc)
What role you would like to serve in the forum? (e.g. listserv, committee member, None)
With which populations do you work?
Affiliations
	Include me on the Genomics Forum listserv
	Include me in online directory

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