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Membership Application
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If you are interested in becoming a member of
the California/Nevada Chapter of ACHSA, complete the following
application, print it, and mail it with your check or money order to
the address below.
Name:
Mailing address:
Name of Organization/Institution:
Address:
Work Tel. No:
E-mail:
Specialty/Discipline:
Position:
Are you a member of National ACHSA? yes no
In order to be a member of the
California/Nevada Chapter of the ACHSA you must be a member of the
national ACHSA: please indicate if you are a member of the national
ACHSA on application.
Annual dues for ACHSA are $65.00. This includes
$50.00 for National dues and $15.00 for State dues.
Please make check payable to: ACHSA,
California/Nevada Chapter, and send to:
Treasurer,
CA-NV ACHSA
PO Box 1511,
Folsom, CA 95763
Membership is open to all individuals
interested in correctional health services.
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