 |
California Healthcare Interpreting Association
CHIA
Membership Form
Click here to print this form and
pay by check. Mail form to:
CHIA Convention
One Capitol Mall, Suite 320
Sacramento, CA 95814
or fax to: (916) 444-7462
To pay by credit card, fill out the form and submit
online
using our secure form!
|
| |
Personal Information
|
| Full Name |
|
| Company Name |
|
| Address |
|
| Address2 |
|
| City |
|
| State |
|
Postal Code |
|
| Phone |
|
| Fax |
|
| |
Individual Membership
|
| |
Sponsoring Membership
|
|
$ 100 |
|
Regular Membership
|
|
$ 35 |
|
Student Membership
|
|
$ 15 |
| |
Organizational
Membership
|
| |
Organizations With Gross Revenues: |
|
less than $500k |
$ 150 |
|
$500k - $2 million |
|
$ 250 |
|
$2 million - $5 million |
|
$ 500 |
|
$5 million - $10 million |
|
$ 750 |
|
Above $10 million |
|
$ 1,500 |
| |
|
| |
Sponsoring Organizations receive newsletters,
standards, listing on CHIA website, 20% off conference exhibit |
|
Sponsoring Partner |
|
$ 5,000 |
| |
All of the above, plus link/logo on
CHIA website homepage, 40% off conference exhibit |
|
Sustaining Parner |
|
$10,000 |
| |
Friend of CHIA |
|
$ |
| |
Payment
Information
|
| Total Due |
|
| Pay by: |
Check (enclosed) |
| |
VISA |
| |
Master Card |
| Name on Card |
|
| Card Number |
|
| Expiration Date |
Month
Year |
| |
|
| |
|
|
|
| |
Your Dues
Support
- Interpreter Certification Pilot training and testing as part of
developing a statewide certification program
- Conducting feasibility study of statewide certification
- Distribution of CHIA standards
- Public education and elevation of the profession through publication
of quarterly newsletter informational website, and hosting of annual
conference
- Advocacy for access to interpreting services
- Funding for research on the value interpreting services brings to
physician/patient interactions and medical marketplace
CHIA Home page |