GEHA Student Membership Application Form

We appreciate your support!

 


Membership Categories:

Student Members: Students enrolled in a course of study with an interest in Environmental Health, Food Science or Public Health, that are not employed full time.

Active Members: those who are employed at or retired from jobs that involve environmental health as a major component of their occupation.

Associate Members: those who provide products for use in environmental health related activities or anyone with an
interest in environmental health.

Honorary membership: bestowed upon members by the Awards Committee.

Voting privileges in Association shall be limited to Active Members and Honorary Members only.

If paying by check; make check payable to Georgia Environmental Health Association and mail to:

GEORGIA ENVIRONMENTAL HEALTH ASSOCIATION
397 Eastman Highway
Hawkinsville, GA 31036
 
Note: Appropriate membership cards issued upon receipt of dues.

* Required


New Membership
Renewal Membership (same address)
Renewal Membership (new address)


 Application Year *


 
Name * ......................First .................................................. Last
             


Home Address * Street
. .City State Zip Preferred Address

Daytime Contact Phone Number


Home Email Address * Preferred Email


School or Agency


Job Title or study major



Business or School Address Street
. .City State Zip Preferred Address


Business or School Email Address Preferred Email


Membership Type * Student Membership - $10

How will you be paying?  (Membership not confirmed until payment received). * Mailing Check or Paying at Conference
PayPal