Please print this page for your records and include a copy when sending your check to:

Dear First_Name,

You have successfully joined or renewed your membership with NY Metro ASHI^® for the period October 1, 2009 through April 1, 2010.

The following is the information you entered:

First_Name  MI  Last_Name

Title, Company
Street
City, State  Zip

Work Phone: Work_Phone

Cell Phone: Cell_Phone

FAX: FAX

E-mail: Email

Website: Website

Membership Type: ASHI_STAT

Member/Candidate #: ASHI_NUMBER

State License Number

NY-NY_LIC_NUM            CT-CT_LIC_NUM

NJ-NJ_LIC_NUM             MA-MA_LIC_NUM

If any of this information is incorrect, please go back to the registration form and change it. 

You may return to the registration form by using the Back button in your browser.

Revised: September 27, 2009 .

UPCOMING EVENTS

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Copyright © 2004 NY Metro Chapter
Last modified: November 11, 2011