HSPC Membership Subscription Personal Info

I would like to receive emails from CSSE's approved partners *

Yes

(this includes but is not limited to - CSSE's Newsletter "CSSE &Beyond", Johnson Insurance, Prolink Insurance, etc)

I would like to receive emails from CSSE's third-party providers that CSSE deems of interest or need to the CSSE membership *

Yes

Address

Address Line 1 *

Address Line 2

City *

Country *

Province/State *

Province/State

Postal/Zip *

Highest Level Of Education Completed

Educational Institution:

Professional Information

Organization Department

Organization Website URL

Current Professional Designation

Work Address

Address Line 1

Address Line 2

City

Country

Province/State

Postal/Zip

Work Phone Extension

Years In Present Position

Years in Related Work

Area of Expertise

Please indicate the principle product manufactured or service performed at your location

Principal Product Offered

Approximate number of employees at your location

List any professional associations of which you are a member and the category of membership you hold

Related Organizations

How Did You Hear About Us?

Encouraged to join CSSE through a member or Chapter event?

Yes

If you request to be listed in the Member Directory in the Members Only area of the website, the information you have provided in this form, ie., place of employment, title, professional designation and expertise will be displayed in the profile.

Do you wish to be listed in the Member Directory in the Members Only area of the website? *

Yes

Username *

Password *

Password Confirmation *

Membership Interval:

04/25/2024 - 04/25/2025, Active as of this Date: 04/25/2024