Washington State Environmental Health Association
Membership Application

All memberships expire 1 year from date it is received.  Please complete and print the form below.   Mail with check or money order made payable to:
WSEHA,  103 Sea Pine Lane, Bellingham WA  98229

WSEHA Membership Categories: (select one)
Regular Member $50.00 Affiliate Member $75.00 Student Member $5.00
Associate Member $50.00 Sustaining Member $75.00 Subscribing Member $20.00
Full Name Degree/Year
Organization School
Job Title    
Home Address:

Work Address:
Address Address
City/State/Zip City/State/Zip
e-mail e-mail
Phone Phone
Fax Fax
Please use my: Home Address Work Address
Major Interest Areas: (check all that apply)
Thank you
for your
Interest in WSEHA!
Air Quality Food Protection Law & Process Hazardous Waste
Housing Institutional EH&S Wastewater Land Use/Planning
Noise Pollution Occupational H&S Vector Control Radiological Health
Solid Waste Toxic Substances Administration Recreational Facilities
Water Quality General EH International Health
Would you be interested in being on a committee?  
Would you like a receipt mailed to you?
Would you be interested in running for office?    
I have read and agree to abide by the WSEHA Code of Ethics.

Date:___________       Signature:______________________________________________