Any person shall be eligible for membership who is engaged in the practice of public health, either directly or indirectly, or who is interested in advancement of public health. 

Mail completed application to:

West Virginia Public Health Association
Treasurer
Post Office Box 11635
Charleston, WV  25339-1635

PLEASE  PRINT

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First Name                           Last Name                                            Date of Birth

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Employer

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Employer Address

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Employer City, State, Zip Code

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Home Address

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City, State, Zip Code

Do you prefer to receive Association correspondence at your Business □   or Home address □?

Are you an APHA member □, Retired □, a WVPHA lifetime member □?

 

Section Affiliation

Select all that apply.  If more than one, please indicate one section as primary:                                                           

Dental	□		Local Health Officers	□
Environmental Health	□		Professional Clerical	□
Finance, Operations & Computer Technology	□		Public Health Nursing	□
Health Administration	□		Public Health Retirees	□
Laboratory / Epidemiology	□		WV Association of Local Health Departments	□

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