Student Membership Application

Student Membership Application

Student Membership (STU) in the Society shall be available to full-time college students taking course work related to any discipline represented by the Society. Students must provide a copy of their transcripts that state their full time, 12+ credit hours. Failure to do so will result in denial of student membership. Student members may serve on committees and participate in the Senior/Fellow Program, but may not vote or hold office.

Invoice will be emailed once membership details have been approved.

• Years 1-3 - $0

• Year 4 - $50

• Year 5 – switch from STU to PAM (Professional Active Member) $150

Terms and Disclosures

Membership dues are effective one year from the date the membership application is accepted and processed. Membership eligibility is subject to the provisions of the American Society for Healthcare Engineering bylaws.

Members may cancel their membership at any time, but any paid dues will not be refunded nor is membership transferable.

Any payments made to ASHE are not deductible as charitable contributions for federal income tax purposes. However, they may be deductible under other provisions of the Internal Revenue Code.

For more information call 312-422-3800 or send an email to ashe@aha.org

Applications may take up to one week to process.

Date

Name

Alternate Email

Designations

School Name

Campus - If applicable

Major/Area of Study

Mailing Address

City

State

Zip

Phone number

Phone

Birthday

Gender

Select or enter value

Ethnicity

Select

Education Level

Select or enter value

Employment

Select or enter value

Signature

I hereby certify that all statements and responses I have made in this application, are true, accurate and authentic to the best of my knowledge. Further, I acknowledge that I have reviewed this submission for completeness and accuracy and understand that an incomplete submission will be deemed ineligible for membership by ASHE. Please check the box below to serve as your official signature.

Must attach full time student transcripts for Student membership. *Not required for NTTC Students.

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