Florida Environmental Health Association

MAIL IN - FEHA Application for Membership

Florida Environmental Health Association
(Includes Subscription to the Florida Journal of Environmental Health)

This page is FOR NEW MEMBERS ONLY

Renewals click here

MAIL-IN MEMBERSHIP APPLICATION
for those not wishing to pay ONLINE via Credit Card.

NOTE: PRINT THIS PAGE AFTER COMPLETING IT AND MAIL IT IN
Your payment options can include credit card, check, or money order.
If paying by check or money order, please include & make payable to "FEHA".

Last Name

First Name

Address

Home Phone

City

State Zip Code

Employed by

Present position

Work Address

Specialty Area:

City

State Zip Code

Work Phone/Suncom

Email Address

Recruited by

FEHA District

ANNUAL DUES: (Membership includes subscription
to the Florida Journal of Environmental Health)

NEW Members applying between January 1 and
May 31 can pay one-half year's dues.

Contributions to the Scholarship Fund can be made with this form - Donation $

Total Amount Enclosed $

Payment Type

If Using a Credit Card:
Billing Address

Name on Card

Account #

Expiration Date

Mail completed application and credit card info or
payment by check or money order payable to "FEHA" to:
Bridget Anderson
FEHA Executive Director
5101 Ortega Boulevard
Jacksonville, FL 32210-8305

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