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WESTERN KENTUCKY UNIVERSITY

Register Online

Submit Your SHA Registration Form Online Today!

For the first time since SHA became a student organization, we will now be able to take your registration form information online. While you will still be responsible for paying your dues in person at the Department of Public Health Office, filling out your registration form online will help to improve the membership process for our members and the SHA leadership team.

Please be sure to complete all the fields below to ensure that your membership file is complete and up-to-date. It is important that all members, whether or not you have been a member before, complete a new membership form each semester/year, to keep our records up-to-date. Ensure that you press the 'submit' button at the bottom of the page to ensure that your membership form has submitted.

Your Full Name*: 

Your WKU ID*: 

Your WKU E-mail*:

Your Local Address*:

City, State, Zip Code *:

Primary Phone Number*:

Secondary Phone Number:

Degree Seeking* (Select One):

      HCA

      MHA

Advisor* (Select One):

      Dr. Gregory Ellis-Griffith

      Dr. William Mkanta

      Ms. Melanie Eaton

Graduation Year (Expected):

Select Membership Type:

      $15 Semester Membership

      $30 Yearly Membership

 

Would you like to purchase an SHA T-shirt during the next order?

     YES

     NO

Would you like to purchase a stole and chord during our next order?

     YES

     NO

 

By clicking submit below, I understand that this serves as my digital signature, consenting to the above information being correct to the best of my knowledge. I understand that it is my responsibility to pay my membership dues at the Department of Public Health in order for my SHA Student Membership to be complete.

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