Application

($50/Year) Certified Member (CHMM, CHMP, HMMT credential)($50/Year) Professional Member (10 years relevant experience, bachelors or higher degree count as 4 years, associates degree as 2 years)($50/Year) Associate Member (stakeholder in the hazardous materials industry)($80/year) Business/Corporate/Organization Membership (includes 2 individuals)($20/Year) Student Membership (full-time student)

First Name

Last Name

Company

Title

Address

City

State

Zip

Home Phone

Work Phone

Cell phone

Membership ID (CHMM or CHMP)

Choose and pay associated dues amount:

[paypalsubmit email:cochmm@yahoo.com itemamount:pricefield50 itemname:desc50 quantity:qty "$50 (Certified Professional/Associate Member"]

[paypalsubmit email:cochmm@yahoo.com itemamount:pricefield80 itemname:desc80 quantity:qty "$80 (Business/Corporate/Organization Member)"]

[paypalsubmit email:cochmm@yahoo.com itemamount:pricefield20 itemname:desc20 quantity:qty "$20 (Student Member)"]