"Serving Sanitarians and Environmental Health Professionals in Texas Since 1956"

www.myteha.org

Application for Fellow Membership
Print this page, fill out form and mail with your $10.00 fee

Name

Current Official Title

Employer

Mailing Address

City State Zip code

 

EDUCATION AND TRAINING

Institution Location Dates Attended Degrees /Certifications
       
       
       

EXPERIENCE (Begin with most recent)

Title Organization/Employer From (Mo/Yr) To (Mo/Yr)
       
       
       

How many years have you been engaged in environmental health work?

Professional Memberships

List other pertinent information (awards received, articles published, presentations, significant accomplishments).

Signature of Applicant___________________________________Date___________________

Information in this application will be submitted to the TEHA Governing Council for approval.

Submit this application and Fellow dues in the amount of $10.00 to:  Steve Berry, RS
                                                                                                   Exec. Secretary – Treasurer
                                                                                                   Texas Environmental Health Association
                                                                                                   P.O. Box 860099
                                                                                                   Plano, Texas 75086-0099