We welcome all interested persons in community health to join our group. There are no fees nor dues. We offer educational opportunities that keep us abreast of health issues that are impacting our communities. Come have a voice in our community health future! Visit the UNA website http://www.xmission.com/~una/ for up-to-date CHNIG information.

CHNIG Membership Application

Please fill out the form below and click the "Apply Now" button below. Or, you can print this page and mail the completed form to

UNA CHNIG
3761 South 700 East
Suite 201
Salt Lake City, UT 84106
phone 801 293-8351
Name:
Address:
City,State,Zip:
Employer:
Title/Specialty:
Home Phone:
Work Phone:
Pager:
Cell Phone:
FAX:
RN: Yes No
UNA Member: Yes No
LPN: Yes No
Student Nurse: Yes No
Interested in serving
on a CHNIG committee?		 Yes No