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Michigan Industrial Hygiene Society
Membership Renewal Request Form - Late Payment Only

Membership dues for the upcoming year are payable between September 1 - November 30 for current members. The MIHS Board has voted that a $5.00 late fee will be applied for dues paid after December 1 (Note: Dues paid prior to September 1 are for the current year only and will be due again during the next dues period).

Please select your membership status and provide the information at the bottom of this form. Indicate your name and complete only those portions of the form which have changed since the last membership year. Please print the completed form for your records and mail a photocopy with you remittance (see instructions below if using Pay Pal to pay Online).

Late Cost Membership Description of Membership Status
$55 Organizational Company published as sponsor in Membership Directory and Mini Conference Program
$30 Full Member in good standing with AIHA
$30 Associate Any person having a professional interest in Industrial Hygiene
$10 Student Graduate or undergraduate student enrolled in occupational or environmental health studies. Persons employed full-time are not eligible for this membership category regardless of their studies.
Offline Membership Renewal Form
 

This form is for those paying with a check. Please print the completed form for your records and mail a photocopy with you remittance (see instructions above if using Pay Pal to pay Online). You will be notified upon acceptance of your application.

> Offline Renewal Form (printer friendly- opens new window)
Online Membership Renewal Form
 

Renewing Members: Use this form to renew membership
If you are renewing your membership complete this short form. Please provide any new contact information or changes in your membership status (new certifications, etc.) as indicated on the form.
*What is your E-mail address? *Required
Enter your contact information below:
*First Name,
Middle Initial, *Last Name:
IH Designation:
 (CIH,CSP, etc. - Please limit to your primary)

My contact and other information remains the same.

IF REQUIRED, please make any changes in the form fields below (do not check above).
Title:
Company:
Address:
 Work Home   
Address 2:
City/State/Zip:
Phone:
   Work Home 
Fax Number:
Additional Information:
Comments:
Membership Level:
*Type of Membership:
  Honorary (send form, dues are waived)
Life (send form, dues are waived)

The following information is optional - select only if changes have occurred:

Which of the following certifications do you hold? (check all that apply)

CIH CSP CHMM
IHT OHST PE
Other: (please list - do not include 40 hr. training classes)

Which related organizations are you a member of?

WMIHS ASSE SOT OPA (DRS)
ACGIH APCA APHA AOHN (NURSES)
Other: (please list)

Which of the following committees do you have an interest in?

Awards International Newsletter 
Community Outreach Legislative Nominating 
Continuing Education Membership Publicity
Program and Arrangements    

Payment Options:


Credit Card Payments - Complete the form, upon submittal you will sent to a new page where you will have the option to link to Pay Pal, click on the membership status you are requesting (If you are paying by check, you may disregard the information found on this page).

Note: You must join Pay Pal (takes about 2 minutes) to use this feature.

Checks by Mail - If you would like to send your payment in check form by mail, please use this form. > Offline Membership Renewal Form



Please press the Send button only once. It may take a few moments to process.

MIHS promises not to use this information in any manner inconsistent with the purpose intended. We will require your E-mail address to contact you with assistance.

 


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   Last Update: September 3, 2008