2019 FL SOPHE Membership Information
2018 Membership Database for Application
Please enter your first name *
Your answer
Please enter your last name *
Your answer
Please list your credentials
(E.g., MPH, CHES, MCHES)
Your answer
Please enter your academic or professional organization affiliation *
Students feel free to simply enter your academic institution
Your answer
Enter your phone number *
Your answer
Enter a secondary contact number
Your answer
Enter your email address *
Your answer
Enter your mailing address *
Your answer
Would you like for your contact information to be included in the chapter's membership directory? *
Would you like to be added to the chapter's listserv? *
Please indicate if you are certified in any of the following *
Required
Are you a member of National SOPHE? *
Local/state SOPHE membership does not mean that you are a national member of SOPHE
How did you hear about FL SOPHE? *
Select all that apply
Required
To join Florida SOPHE, please select a membership category *
Students will need to submit proof of student status (i.e. semester schedule, instructor letter. etc.) after their information has been recieved
All members must serve on a committee. You may choose more than one to serve on. *
Please select all committees that you wish to serve on
Required
Please indicate other areas of interest *
Required
Each year, FL SOPHE is required to submit an Annual Report with member and chapter information to the National SOPHE office, including number of members and demographic breakdown. Demographic Information is shared with SOPHE on a group level, and is not personally identified. Please note: This information is optional to provide and has no bearing on your application or membership status. *
Race and Ethnicity (Please mark all that apply): *
Required
FL SOPHE plans to have two general member meetings per year (currently by phone/webinar). What is the best time of day for you to meet (EST)? *
Required
What is the best day of the week for you to meet? *
Required
What would make it difficult for you to attend meetings? *
Required
What types of activities / programming would you like to see FL SOPHE offer? *
Required
What motivated you to join FL SOPHE? *
Required
How can we reach new members? *
Required
Please note that payment will be accepted via SquareCash or PayPal. If you Opt for Square Cash payment, the treasurer will contact you. PayPal payments can be made at the bottom of our home screen under membership types: https://www.flsophe.org/ *
Please select your payment preference
Thank you for completing this form. If you have any questions, please contact FL SOPHE: info.flsophe@gmail.com or our treasurer at: flsophetreasurer@gmail.com
After your form has been received, you will be contacted by the treasurer to make your dues payment.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy