Member Application VOS Membership Form Step 1 of 4 25% Membership Application Type*Please select what type of application you are submitting today. New Membership Application Renew Membership Online/Pay Annual Dues Name* First Last Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Name Business Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Business PhoneEmail* Enter Email Confirm Email Preferred Mailing* Home Business Experience Record*Date FromDate ToEmployerAddressPosition ReferencesPrint Name and Address of one or more VOS member(s) who are familiar with your work in the field. BiographyBriefly describe your areas of expertise or attach a resume or curricula vitae Place of Birth Birth Date MM slash DD slash YYYY EducationYour professional designationsPlease list which professional designations apply to you (ie. CSP, PE, CIH, etc)Safety, Health or Environmental Professional Societies Membership, Activities, Offices I hereby apply for the classification of:* Member - $50.00 - 10 years experience Associate - $50.00 - 5-10 years experience Affiliate - $25.00 - less than 5 years experience Member Emeritus - $25.00 - retired members with Board approval Are you changing your current membership classification? No Yes Donation to receive a printed and mailed newsletter Price: $ 5.00 Quantity: 70th Anniversary CoinA limited supply remains if you would like one or two Price: $ 5.00 Quantity: Additional donation for VOS Student Scholarship Fund Classification/Re-classification Fee Price: Total $ 0.00 Credit Card Billing Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name
