2021 FL SOPHE Membership Application
2021 Membership Database (Application)
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First Name *
Last Name *
Please list your credentials (E.g., MPH, CHES, MCHES)
Please enter your academic or professional organization affiliation *
Students feel free to simply enter your academic institution
Enter your phone number *
Enter a secondary contact number
Enter your email address *
Enter your mailing address *
Would you like for your contact information to be included in the chapter's membership directory? *
Would you like to be added to the chapter's listserv? *
Please indicate if you are certified in any of the following *
必填
Are you a member of National SOPHE? *
Local/state SOPHE membership does not mean that you are a national member of SOPHE
How did you hear about FL SOPHE? *
Select all that apply
必填
To join Florida SOPHE, please select a membership category *
Students will need to submit proof of student status (i.e. semester schedule, instructor letter. etc.) after their information has been recieved
All members must serve on a committee. You may choose more than one to serve on. *
Please select all committees that you wish to serve on
必填
Please indicate other areas of interest *
Each year, FL SOPHE is required to submit an Annual Report with member and chapter information to the National SOPHE office, including number of members and demographic breakdown. Demographic Information is shared with SOPHE on a group level, and is not personally identified. Please note: This information is optional to provide and has no bearing on your application or membership status. *
Race and Ethnicity (Please mark all that apply): *
必填
FL SOPHE plans to have two general member meetings per year (currently by phone/webinar). What is the best time of day for you to meet (EST)? *
必填
What is the best day of the week for you to meet? *
必填
What would make it difficult for you to attend meetings? *
必填
What types of activities / programming would you like to see FL SOPHE offer? *
必填
What motivated you to join FL SOPHE? *
必填
How can we reach new members? *
必填
Please note that payment will be accepted via PayPal. *
Please select your payment method
Thank you for completing this form. If you have any questions, please contact FL SOPHE: info.flsophe@gmail.com or our treasurer at: flsophetreasurer@gmail.com
After your form has been received, you will be contacted by the treasurer to confirm we are in receipt of your payment.  
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