Regional Chapter
Member Update OR
New Membership Application

To be a well connected member, we need accurate contact information. This information stays within MiSHE and is not sold or distributed. If you are updating/renewing membership, please fill out this form.

In order to become of member of MiSHE (the state chapter), you must become a member of one of five Regional Chapters. Please read the MiSHE Bylaws for qualifications to become a member as a Professional,  Associate, Education/Mentor, etc.  Check the bylaws of your Regional Chapter (from the MiSHE main page) for any other regional qualifications.

Directions: Please fill-in the registration form below. When complete, be sure to click on the submit button at the bottom of this page. Clicking the submit button affirms your intention to renew or join to support, promote, and further the objectives of your regional and state chapter.

CHECK ONE OF THESE TWO BOXES BEFORE CONTINUING WITH THE FORM

Check here if you are updating your membership information : I am updating my information

Check here if you are applying for membership: I am applying for membership

New Members: You can apply for membership in any of the Regional Chapters within Michigan. This application for membership will be forwarded to the Regional Chapter of your choice. Please click on this link to Michigan Map of Regional Chapters if you are not sure which Regional Chapter serves your location. You will be contacted regarding your acceptance, membership fees, and any other aspects of membership.

Please identify the category of membership and your regional chapter (Note: See Bylaws link above for membership category definitions):
 I want to renew/apply for Professional Membership.

I want to renew/apply for Associate Membership

I want to renew/apply for Student/Mentor Membership.

I want to renew/apply for Regulatory/Liaison Membership.

I want to renew/apply for Honorary Membership.

I want to renew/apply for Lifetime Membership.

Type the two letter code for the Regional Chapter you would like to belong to (UP, NC, EC, WM, SE)

First Name Middle Initial Last Name

Title

E-mail Address (Do not leave this blank. Home or work address is acceptable)

Healthcare Institution OR Business Name

Address P.O. Box

City, State Zip Code

Phone    ext  Pager

Fax Cell Phone Alternative Phone

Optional Information: In the event you change jobs we may still be able to contact you.

Home Address (include City, State & Zip)

Home Phone

Home E-mail Address

Professional Certification

 Mark the professional certification you currently hold:

ASHE Member (American Society for Healthcare Engineering)

CMFM (Certified Healthcare Facilities Manager)

SASHE (Senior ASHE)

FASHE (Fellow ASHE )

LEED (Architect/Engineering Related)

PE (Professional Engineer)

List any other certification that you feel is appropriate

Professional Associations

 List up to two professional associations in which you hold an active membership and offices that you hold or have held in the past. Do not abbreviate. Please specify years of active service.

  Position Held                                        Organization Name & Location                           From - To

        

        

        

Interest Information

 List your area of interest and potential contribution to the Society in the spaces below. Please list at least one narrow interest within your area of interest. Areas of interest could be technical, managerial, construction, etc.  Your areas of interest will help to shape the educational offerings of the chapter and help to identify talent in those interest areas.

 

Click here when the form is complete.