Welcome
Membership forms  - Snail mail and Email versions
                                                                               

VT/NH Society for Histotechnology

Membership  Application

 

 

 

New_____________   Renewal______________

 

Name________________________________________________

                                    (please print)

Street Address_________________________________________

 

City_______________________State_______________Zip______________

Day Phone______________________ Evening Phone___________________

Email Address_____________________________________________________

Name of Employer_______________________________________________

Your position Supervisor_______Staff Tech_____________ Other ____________

Educational Status____________________ Certifications________________________

Annual Dues $10.00

 

Please submit check payable to VT/NH Society of Histotechnology and mail application to:

                                    Diane Weishaar

                                    3 Pleasant Street

                                    St. Albans, Vermont 05478




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VT/NH Society of Histotechnology Email Membership Application

Name: *
Address: *
City: *
State: *
Zip Code: *
Email: *
Day/Eve Phone: *
Employer Name:
Current Position:
Educational Status:
Certifications:
  New   $10
 
 Renewal   $10

Please submit check payable to VT/NH Society of Histotechnology
and mail to:

Diane Weishaar
3 Pleasant Street
St. Albans, VT 05478

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