Membership Update Form


	New England Chapter of the Health Physics Society


	*Membership Information Update Form:*

		(for current members only to update their existing information; new members should go to the New Membership Form)

Please only fill in information that you need to change!
Action Requested:		Membership Information Update
Change my Name to:
		First
		Last
		Middle
		Title and/or Certifications
Change Business Address to:
		Company / Organization Name
		Street / Suite Number / PO Box
		City
		State
		Zip Code
Change my Home Address to:
		Street
		Apartment # / Building / PO Box
		City
		State
		Zip Code
Change my Contact Info. to:
		Business Phone Number
		Home Phone Number
		Business E-Mail
		Home E-Mail
		Business Fax
		Home Fax
Change Mailing Address to:		Business Address
		Home Address
National HPS Member?		No
		Yes ( indicate date of membership)


Any Other Changes?

NOTE: Submitting information via the NECHPS web site does not work for everyone because Internet Explorer uses the locally installed mail client to send mail whereas Netscape uses its own internal sendmail code (it should always work). So please ensure that your Internet Explorer default e-mail client is the one that you use. This works best if your default system is Microsoft Outlook Express or Outlook 2000. If your default e-mail system is AOL, please ensure that you are logged onto AOL at the time you hit the “Submit” button.

Netscape users should upgrade to NetScape 7.1 or better.
It is FREE @ http://channels.netscape.com/ns/browsers/download.jsp.