MEMBERSHIP LIST

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CHANGE OF ADDRESS/INFORMATION FORM

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The ONLY way that the Health Services Association California Community Colleges Directory can be kept up to date is by you taking a few minutes to make any needed changes. When a change occurs, complete the appropriate section and mail the downloaded form to:

Susan Broderick, R.N.
broderic@sbcc.edu
(805)965-0581 ext. 2299, FAX 560-6572

GRANT REQUEST APPLICATION

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The Health Services Association California Community Colleges (HSACCC) requests proposals from HSACCC member institutions/individuals interested in securing funding that advance the mission and goals of HSACCC:

APPLICATION

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MEMBERSHIP ENTITLES YOU TO:
Minutes of the Meetings
Stethoscope Newsletter
Reduced Registration Costs for Meetings

HOW TO RENEW:
Please check the membership category desired and provide the information requested on the downloaded form. Mail completed information and check payable to "HSACCC" to:

Alfred E. Forrest, MD, HSACCC Treasurer
Student Health Services
Rio Hondo College
3600 Workman Mill Road
Whittier, CA 90601-1699
E-mail questions to aforrest@riohondo.edu

REGULAR MEMBERSHIP (Voting)
Each institution is eligible to cast one vote. A minimum of one Regular Membership per institution is required.
...$75.00

ASSOCIATE MEMBERSHIP (Non-Voting)
Open to health services professionals and other interested persons (i.e. Substitutes, Consultants, Student Services Administrators, Part-Time employees).
...$25.00

EMERITUS (Non-Voting)
Granted by the organization upon individual's retirement.
...No Dues

HONORARY (Non-Voting)
For distinguished contribution to the aims of the organization. Appointed by Executive Committee and approved by membership.
...No Dues

TRAVEL REQUEST FORM

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