Regional Chapter
New Membership Application

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 join, support, promote, and further the objectives of your regional and state chapter.

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:
 I want to apply for Professional Membership.

I want to apply for Associate Membership

I want to apply for Student/Mentor Membership.

I want to apply for Regulatory/Liaison Membership.

I want to apply for Honorary Membership.

I want to apply for Lifetime Membership.

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

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

City, State Zip Code

Phone    ext

Fax

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.