OCAIHA Membership Form

Orange County AIHA 2004 - 2005 Membership Form

Annual Membership Dues -
Membership Dues:
Jan-June: $ 20.00
Annual Membership: $40.00
Student Membership - $20.00 (Full-Time Students, Anyone Unemployed)
Retired - No Charge

Name________________________________________________ CIH: ____Yes ____No Company_________________________________________________________________
Mailing Address*___________________________________________________________ City____________________________________ State______________________ Telephone*_______________________________ Fax_______________________
Email____________________________________________________________________

* Address and Telephone Number will appear in the membership directory

Amount Enclosed        ____$40.00        ___$20.00       ___Retired
Address Change         ____ Yes           ___ No
Are you a member of National AIHA? ____ Yes           ___ No

Make Checks Payable to OCAIHA and return form with check to: OCAIHA
P.O. Box 4704
Irvine, CA 92616-4704

Section member benefits:

Support legislative advocacy of the IH profession through the California Industrial Hygiene Council

Reduced Orange County Section meeting charges

Local Section newsletter “The Orange PEeL”

Networking through meeting announcements & social activities

Reduced symposium registration fees

Employment search support

OCAIHA Tax Payer Federal I.D. # 31-1272346

Print this page and send completed form with payment to the above address.
MEMBERSHIP DUES PAYMENTS ARE APPLICABLE FROM JULY 1, 2004 to JUNE 30, 2005.