CCIH Membership Application - College or University
The mission of Christian Connections for International Health (CCIH) is to promote global health and wholeness from a Christian perspective. CCIH shares information and provides a forum for dialogue, networking, and advocacy to the spectrum of Christian organizations and individuals working in global health.

The CCIH Board of Directors will review your application and inform you of its decision.

School Name *
Your answer
Primary Contact Information
Please complete the fields below for your school's primary point of contact.
First Name *
Your answer
Last Name / Surname *
Your answer
Position or Job Title *
Your answer
Email Address *
Give direct email address of primary contact, not general school email address.
Your answer
Phone Number *
Give direct line of primary contact, not general school phone number.
Your answer
Mailing Address *
If you are a department or division within a larger school, give the mailing address for your office (not general school address). Remember to include your country if outside the U.S.
Your answer
Yearly Dues
Dues must be paid annually and are based on the calendar year. Applications approved after November 1 will apply to the following year.

2017 dues:
Student Club or Group: $85
University/College Department: $275
Entire College/University: $575

Dues Payment (Select one) *
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