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ABIH CM

   

 

 
Membership

1. Fill in the following fields.
2. Print the completed form.
3. Enclose check for dues, payable to WNY AIHA Section
4. Mail to:

Rick Rote
985 Cane Patch
Webster, NY 14580

If submitting application electronically, email to Rick Rote at:

rrote@labellapc.com
 

Name:        

* Employer:

* Address:
  Check one:  Business
Home

Check here if you do NOT want your information published in the Membership Directory.

* Telephone:
           voice:        
                     
  Area Code

           fax:            
                      
Area Code

E-mail (important!): 

* National Member:
   If you are not a national member, you are applying for associate membership.
  Check one:
Yes Member Number                              No

* Please list main areas of interest in IH:

 

DUES (check one):

 

$20.00 per year: 

 

If retired: $5.00 per year:

 

If student: (no charge):

School: 

 

Faculty Advisor:

Enclosed is a check payable to : WNYAIHA Section

Return to:


Rick Rote

Secretary/Treasurer WNYAIHA

PO Box 92551

Rochester, NY 14692