American Industrial Hygiene Association

Pittsburgh Section

Corporate Sponsor Application Form

This year's Corporate Sponsorship drive is underway!  The benefits of a Corporate Sponsorship contribution of $150 include:

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:

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: September 19, 2012.