FHEA.org - Florida Healthcare Engineering Association

Name:(First, Middle initial, Last)

Your Title:

Company:

Address:

City:

State:

Zip:

Office Phone:

Fax:

E-mail

Company Website URL:

Products and/or Services / Specialty

Category of Company, i.e., Construction/Design, MEP, etc.

ASHE Membership: Are you, or anyone in your company, a member of ASHE, the national association of which FHEA is an affiliate chapter?

Yes, I am currently

I plan to join this year.

Other individual(s) in my company are ASHE members. (Please include name(s) and contact info):

Districts you would like to participate in

1- NW Florida (Panhandle)

2- NE Florida

3- Central Florida

4- South Florida

5- All Districts

Please Enter the number 1 next to the membership of your choice: FHEA Supporting Membership Renewal	$50.00
New FHEA Supporting Membership	$50.00