Healthcare Facilities Management Society of New Jersey

Membership Application Form

Requirements:

Regular Member - this level of membership in the Society shall be available to individuals who are actively employed in a facilities management capacity at a Health Care Facility. Such membership shall also extend to their assistants and supervisory personnel of other facilities management related fields. Members in this category are eligible to vote and hold office.

Professional - this level of membership in the Society shall be available to those professionals who provide support functions to the facilities management staff of a healthcare institution. Such individuals are identified as licensed architects, licensed engineers and other professional consultants whose firm(s) are active in the healthcare field. Individuals in this category are eligible to vote but may not hold office. At the discretion of the Executive Committee, limitations may be placed on the numbers of this category of member to insure a proper balance of membership.

Professional Associate - This level of membership in the Society shall be available to those who provide facilities related support services to healthcare institutions and whose membership would be of benefit to the organization. Individuals in this category are eligible to vote or but may not hold office. At the discretion of the Executive Committee, limitations may be placed on the numbers of this category of member to insure a proper balance of membership.

I hereby apply for Membership in the Healthcare Facilities Management Society of New Jersey.

First Name:
Last Name:
Home Address Line 1:
Home Address Line 2:
Home City:	State: Zip:
Home Phone:
Cell Phone:

Employer
Position/Title
Business Address Line 1
Business Address Line 2
Business City:	Business State: Business Zip:
Business Phone:	ext.
Business Fax:
Email:

A.S.H.E.:	ASHE Number:
A.I.A.:
B.O.C.A.:
N.F.P.A.:

Educational Degrees, Licenses, Certifications	(For information only)
Membership Type:	Regular Member: $100 ($60 initiation, $40 annual dues) Professional Member: $200 ($60 initiation, $140 annual dues) See note below… Professional Associate Member: $275 ($60 initiation, $215 annual dues) See note below…
	Note: Due to membership restrictions in the “Professional and Professional Associates” categories, Send the Completed Application ONLY. DO NOT SEND A PAYMENT. You will be placed on a waiting list until such time a vacancy becomes available.

	Please indicate Committee Involvement. (Please check off 2 from the list below.) Engineering Advisory Board Safety Ad Journal Newsletter Social Justice Advocacy Website Golf Outing Vendor Liaison Levels of Affiliation Public Relations Codes and Standards ASHE Advocacy Liaison Education Membership Audio/Visual Photographer

Sponsor:
Notes:

	To reduce spam from automated delivery systems, we ask that you click the I'm not a robot checkbox below and wait for the checkmark to appear before pressing submit. Final approval of all applications rests with the HFMSNJ Executive Committee