Membership Please indicate the quantity you would like for each type of membership shown below. Then click on "Continue" to confirm your order selections and total. After that we will ask for your name and address information and your payment information to complete your order on our secure server.   REGULAR MEMBERSHIP Person engaged or interested in any branch of public health work in California.   Order at $55.00 each     REGULAR MEMBERSHIP - Two Years Person engaged or interested in any branch of public health work in California (two-year membership).   Order at $100.00 each     STUDENT MEMBERSHIP Student enrolled in a professional curriculum related to public health, includes up to one year after graduation.   Order     RETIRED MEMBERSHIP Member who has retired from active employment.   Order at $25.00 each     RETIRED MEMBERSHIP - Two Years Member who has retired from active employment (two-year membership).   Order at $45.00 each     COMMUNITY/SPECIAL HEALTH WORKER For person working in community public health programs whose annual salary is less than $40,000. Part-time students and post doctoral candidates may also be eligible.   Order at $25.00 each     CORPORATE/INSTITUTIONAL MEMBERSHIP - under 10 employees - Includes two full memberships plus 20% discount to all other employees for individual memberships, and 20% discount for all other nonmember employees to attend annual meeting and CE conferences and events throughout the year.   Order at $200.00 each     CORPORATE/INSTITUTIONAL MEMBERSHIP - under 500 employees - Includes two full memberships plus 20% discount to all other employees for individual memberships, and 20% discount for all other nonmember employees to attend annual meeting and CE conferences and events throughout the year.   Order at $500.00 each     CORPORATE/INSTITUTIONAL MEMBERSHIP - over 500 employees - Includes two full memberships plus 20% discount to all other employees for individual memberships, and 20% discount for all other nonmember employees to attend annual meeting and CE conferences and events throughout the year.   Order at $1,000.00 each     DONATION Any amount over membership dues. Tax deductible. Minimum online donation $10.   Enter the amount of your choice. Two decimal places (.00) will be assumed unless you enter a decimal value. Minimum: $10.00     DUAL AFFILIATE MEMBERSHIP WITH SCPHA This dual affiliate membership includes full membership in both CPHA-N and the Southern California Public Health Association for $80 reflecting a savings of $25.   Order at $80.00 each     ADD PARTNER MEMBERSHIP WITH NCSOPHE ADD NCSOPHE to any existing regular membership for an additional $25.   Order at $25.00 each     ADD DUAL AFFILIATE MEMBERSHIP WITH SCPHA ADD SCPHA to any existing regular membership for an additional $25.   Order at $25.00 each

Activity Questionnaire CPHA-N • California Public Health Association-North has requested that its customers provide the following information to better help it fulfill your order. Required questions must be answered in order to complete your order.    Degree(s) you hold:        Is this a membership renewal? **Required YesNo  Are you a member of the APHA? **Required YesNo  School (for student members):        Special areas of interest. Please select all that apply. Mac users hold down "Command" key to select multiple responses. **Required AgingAdvocacyClimate ChangeChiropracticChronic Disease ControlCommunity HealthEpidemiologyHealth AdministrationHealth AccessHealth Education & PromotionHIV/AIDSInfectious DiseaseLGBT IssuesMaternal & Child HealthNutritionOccupational/EnvironmentalOral HealthPodiatric HealthPublic Health LawPublic Health NursingPublic Health LaboratorySocial WorkSubstance AbuseViolence PreventionWorkforceOther (Fill in below) Hold down the "Ctrl" key to select multiple responses.  Other special areas of interest:

CPHA-N • California Public Health Association-North Purchase/refund policy: Please contact CPHA-N Office: phone (925) 680-1166 fax (925) 476-0212 email office@cphan.org Acteva's Purchase/refund policy: Refunds and cancellations are provided only at the discretion of the organization hosting or sponsoring this event. Acteva issues credits only when directed to do so by the sponsoring organization. Contact refunds@acteva.com or the sponsoring organization for further details.