NJEHA Conference and Meeting Honorarium

Instructions: Complete the application legibly and in its entirety. Illegible or incomplete applications will be rejected. The Gary S. Strauss Scholarship Fund Conference Honorarium is available only to NJEHA Active Members in good standing. Submit completed application by the deadline of February 15th via email to Virginia Wheatley at: Virginia.Wheatley@doh.nj.gov. Successful applicants will be notified no later than February 22nd.

Name

First NameLast Name

Phone Number

Area CodePhone Number

Fax Number

Area CodePhone Number

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are you an Active Member (in good standing) of the New Jersey Environmental Health Association?

Have you ever attendedthe NJEHA Annual Educational Conference in Atlantic City previously?

Will your employer fund any or all of your NJEHA Conference attendance costs?

List any civic groups,associations and/or other communityorganizations of which the Applicant is a member.

Attach a brief statement describing why you want to attend the NJEHA Conference.

Signature (Please Type Your Name in the Box that you agree to all terms and conditions.)

The Annual Conference Honorarium provides financial assistance to NJEHA members attending the Association’s annual conference. Recipients will be reimbursed after attending the conference and submitting a conference-related article for publication in the NJEHA newsletter. Articles must be a minimum of 150 words, summarize or reflect on the conference experience, and be submitted by May 1 for consideration.