Indiana Environmental Health Association
P.O. Box 457 Indianapolis, Indiana 46206-0457
Name: _______________________________________________________
Title: ________________________________________________________
Company/Department: __________________________________________
Address: ______________________________________________________
City State Zip: ________________________ _________ ______________
Residence Address: _____________________________________________
City State Zip: ________________________ ______ _________________
Email: _______________________________________________________
Business Telephone: ____________________________________________
College or University Attended: ___________________________________
For Mailing Purposes Please
Circle One:
Business Address
Residence Address
Make Checks Payable to: IEHA
Mail Application to:
IEHA
P.O. Box 457
Indianapolis, IN 46206-0457
Membership Dues
Renewals
Before Jan. 31………..$25.00
Feb. 1 to Dec. 31…….$37.50
New Members
Before Apr. 1…………$15.00
Apr. 2 to June 30……..$11.25
July 1 to Dec.31………$7.00
Sustaining*……………$100.00
*Includes one free ad (business card size) in the Journal of Environmental Health, free booth space at the fall conference, vote and publications.
Student:……………….$5.00
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