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Michigan Industrial Hygiene Society
New Member Online Request Form (Pay Pal)

Checks by Mail - If you would like to send your payment in check form by mail, please use the following form: Offline Membership Request (printer friendly - opens new window)

Yes! I want to join Michigan Industrial Hygiene Society.

*What is your E-mail address? *Required
Enter your contact information below:
*First Name,
Middle Initial, *Last Name:
Title:
Company:
*Address:
 Work Home 
Address 2:
*City/State/Zip:
*Phone:
   Work Home
Fax Number:
Web Site Members Area Login Information:
*Requested User Name:
We suggest first initial and last name.
*Password:
Membership Level:
*Type of Membership:
  Honorary (send form, dues are waived)
Life (send form, dues are waived)
Additional Information:
Comments:

The following information is optional:

Which of the following certifications do you hold?

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:

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.



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