2015 NJSH Membership Application



Name:

Address:

City:      State:      Zip:

Home Phone:      Home Email:

Employer:      Department:

Work Address:

City:      State:      Zip:

Work Phone:      Fax:      Work Email:

Send Correspondance to:  Home      Work                      Include me in the NJSH Directory:     Yes      No

NJSH Membership:  Renewal      New      Student


Please check all that apply


Memberships:  NSH Member      ASCP Member

Certifications/Degrees:  HT       HTL      AS      BS      MS      PhD/MD/DVM

Type of Work Place:  University      Hospital      Private Lab      Veterinary      Pharmaceutical      Sales/Service

Species:  Human      Animal      Insect      Plant

Tissue Processing:  Paraffin      Plastic      Frozen

Special Tissues:  Hard Tissue      CNS Tissue      Eyes      Biopsies

Special Procedures:  Enzyme Histochemistry      Immunohistochemistry      In Situ Hybridization      Autoradiography

Image Analysis      Confocal Microscopy      TEM      SEM      Molecular Techniques

Microwave Techniques      Perfusion      Exfoliative Cytology      MOHS      LCM