American Industrial Hygiene Association

Pittsburgh Section

2008-2009 Corporate Sponsor Application Form

The 2008-2009 Corporate Sponsorship drive is underway! New this year, the benefits of a Corporate Sponsorship contribution of $150 include:

	2 free local section individual memberships,
	a 1-year listing on the Pittsburgh AIHA Consultants List page,
	a 1-year listing on the Pittsburgh AIHA Corporate Sponsors page, and
	your company will also be noted in at least 2 issues of our local section newsletter.

To become a Corporate Sponsor - Simply fill in the Corporate Sponsorship Application Form below and click "submit" - Within a few days, you will receive an invoice via email that can be paid by Credit Card using PayPal. Or you can print the invoice to send in with payment. Your listing will be added to our website once payment is received.

Note 1: As a Corporate Sponsor, you will not need to complete a "Consultants List Application Form". The information you provide below will be used for your listing on the Consultants List. An example of a company listing is provided at the bottom of this page for your information.

Note 2: As a Corporate Sponsor, you will not need to complete a "Membership Application Form" for the two individual members listed on this form.

Any questions? Please contact Christy Kirsch at kirsch211@comcast.net or at 724-941-5084.

Service Areas Key to be used when completing your form below
(you should choose all that apply):

1 - Asbestos	14 - Lead
2 - Biological Monitoring	15 - Management/Audits/Inspection
3 - Comprehensive IH Practice	16 - Mold Remediation
4 - Computer Software/Information Services	17 - Noise Control/ Hearing Conservation
5 - Emergency Management/Disaster Planning	18 - Radiological Control
6 - Equipment and Supplies	19 - Respiratory Protection/PPE
7 - Ergonomics	20 - Risk Assessment
8 - Environmental Practice	21 - Safety Specialist
9 - Environmental & Occupational Medicine	22 - Training/Instruction
10 - Expert Witness	23 - Toxicology
11 - Indoor Air Quality	24 - Ventilation
12 - IH Instrumentation and Supplies	25 - Vibration
13 - Laboratory/Analytical Services

Corporate Sponsor Application Form: Complete the form below and click "submit listing" to submit your application.

Company Name: *
Contact Name: *	*Name to be listed as Corporate Sponsor/Consultants List Contact*
Contact Email Address: *	*This email address will be listed as the company contact email address*
Phone: *
Fax:
Member 1:	New Member to Pgh. AIHA Existing Member
Member 2:	New Member to Pgh. AIHA Existing Member
Company Address: *
Service Designation:	Residential Commercial Both
Service Areas:	List all service area numbers from the list above that apply to your company
Company Website Address:
Items marked with an asterisk *()** are required.

Example of Listing for Consultants List Page:

Your Company Name [C-6,11,12,17,19,21,23]
1234 Main Street
Anywhere, PA 12345
Contact: John Smith
Tel: (800) 456-0000
Fax: (800) 456-0001
Email: johnsmith@yourcompany.com
Website: www.yourcompany.com

Last revised: August 26, 2008.

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