Membership Application Membership Type *NewRenewalName *Title *Organization *Email Address *PhoneStreet Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodeWebsiteChoose a membership levelChoose all that applyCompany Membership – includes up to 4 individuals from the same company plus a LEHA website link to the member’s company website – $150/yearNon-profit Agency/Organization Membership – includes one individual from the agency or organization plus a LEHA website link to the agency or organization – $75/yearAdd MembersList up to four representatives of your company who should be listed as LEHA members.Member NameMember TitleMember EmailMember NameMember TitleMember EmailMember NameMember TitleMember EmailMember NameMember TitleMember EmailPayment DetailsPay byCredit CardCheckAmount to be charged *USDPlease be sure to enter correct amount based on selection(s).Credit / Debit Card *Submit Form
