American Industrial Hygiene Association

Georgia Local Section

APPLICATION for MEMBERSHIP

Name:
Title (if appropriate): (e.g. CIH, CSP, IHIT, COHST, OSP, etc.)
Mailing Address: Work Phone: Fax:	Is this your work or home address? Work Home If you're using your home address as your mailing address, please tell us the name of your company or employer.
Send Email to:	If you don't have email, type "none"
Are you a National member of AIHA? Yes No	If not, you can call (703) 849-8888 to obtain an application.
Employer Catatory: Consultant? Yes No	Government Commercial / Industrial Education Self Employed Student Vendor Other
Date:	Membership Category (see bylaws)? Full ($20)Associate ($20) Emeritus (Retired - No Charge)

To process this application, please mail your check (payable to the Georgia Local Section, AIHA) to:

Treasurer, Georgia Local Section, AIHA
GTRI
430 Tenth St. NW, North Bldg.
Atlanta, Ga. 30332-0837

Phone: 404-407-6643