Institutional Membership Application

Ready to join the CSHEMA community? That's great! Please complete the information below and we will contact you within one business day with an invoice and arrange for payment. 

Institution Name
Number of EHS Employees
     

Mailing Address
 
City
State/Province
ZIP/Postal Code
Phone

Each institutional member can designate up to three voting members. Please indicate your voting delegates below:

Main Institutional Contact*
Title
E-mail
Phone

*The main institutional contact is the individual that receives official information related to your institution's membership and can manage your membership roster online

Voting Member #2
Title
E-mail
Phone
Voting Member #3
Title  
E-mail
Phone

Thank you for joining CSHEMA! If you have questions, please don't hesitate to contact our Central Office staff at 812.245.8084 or info@cshema.org.

Campus Safety, Health, and Environmental Management Association | One City Centre, Suite 204 | 120 W. Seventh St. | Bloomington, IN 47404
812.245.8084 | 812.245.6710 FAX | info@cshema.org

© 2018 CSHEMA