WSEHA Membership Application

Washington State Environmental Health Association, Inc.
Membership Application

All memberships expire October 1^st of each year regardless of when you join. Please complete and print the form below. Mail with check or money order made payable to:
WSEHA, 103 Sea Pine Lane, Bellingham, WA 98229-9363

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				Sponsored by

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 like your CEU's tracked? Would you be interested in running for office?

I have read and agree to abide by the WSEHA Code of Ethics.

Date:___________ Signature:______________________________________________