Online Membership Application

Personal Information

Name:

Mailing Address Preferred:

Residence:

Business:

E-Mail:

Membership

Type Of Membership:

Affiliate Member ($25/ year): A professional in the field of hazardous materials management who is not certified as a hazardous materials manager.
Certified Member ($25/year): Certified Hazardous Materials Manager
Student Member ($10/year): A full-time student at an accredited college, university or institution

Directory Listing

We plan to provide a list of members, subject of expertise and contact information in a secure, password protected, members only section of our web site. The purpose of this is to provide a source of networking contacts to fellow members. Contact information will be email address only. No phone numbers will be listed.

I to be listed in the Queen City ACHMM Members Directory.

Areas Of Expertise:

Bio: (Optional) Paste your work bio here or email it to info@queencitychmm.org.

Username and Password

Please select a Username and Password to be used by you to access our discussion forum and secure directory. Please choose something that you can remember and is at least 6 characters, numbers or combination.

My Username:

My Password:

Additional Information

If you have any additional information or comments, please list them here.