CA4HA & NAE4HA Membership 2006

* = Required
Question	Response
* First Name
* Last Name
* Position Title
* County
* Address
* City
* Zip
Phone
* Fax
E-mail
Membership Type
Combination CA4HA and NAE4HA Memberhips	State Membership and First Time National Membership - $65.00 State Membership and Renewal National Membership - $90.00 California Life Membership and National Life Membership (retirees) - $295.00 California Affiliate Membership and National Affiliate Membership - $90.00
CA4HA Membership Only:	State Membership (Only) - $25.00 Life Membership (Retiree) - $100.00 Affiliate Membership - $25.00
NAE4HA Membership Only	First Time National Membership Renewal National Membership Life Membership (Retiree) Affiliate Membership
Committee Involvement
Professional Improvement Committee and Subcommittee	Professional Improvement Committee Chair/Co-chair Professional Improvement Subcommittee Programs Subcommittee Diversity Subcommittee
Communications and Recognition Committee and Subcommittees:	Communications & Recognition Committee Chair/Co-chair Newsletter Subcommittee Public Relations and Information Subcommittee Member Recognition Subcommittee
Demographic Tracking
Research Consent
Do you give consent to be contacted as a research subject for research projects aiming to enhance or understand the profession and/or the professional?	Yes No
Do you give consent to be contacted as a source for possible pilot-tests in your county or areas served?	Yes No