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AIHA Utah Membership Form (2024)
Update your contact info or pay dues for the year!
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* Indicates required question
Purpose
*
Update Contact Information
Annual Dues Payment (New and Returning Paid Members)
Other:
Membership Type
*
Choose
2024 Paid Membership ($35)
2+ Unpaid: 2024 Paid Membership ($70)
Student Membership ($0)
First Name
*
Your answer
Last Name
*
Your answer
Address
*
Your answer
City
*
Your answer
State
*
Your answer
ZIP
*
Your answer
Phone Number
*
Your answer
Email
*
A work email is acceptable, but you must provide an updated email upon change of employer.
Your answer
Committee Membership
If you would like to volunteer with a committee in our local section, check the appropriate boxes below.
Marketing, Partnerships, and Communication
Awards and Recognition
Emerging Technologies
Students and Early Career Professionals
None
Suggestions
Let us know if you have any ideas, suggestions or other feedback regarding our section!
Your answer
Payment
Please pay appropriate dues to the
AIHA-UT Venmo
. Students may proceed without doing so.
Submit
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