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Yes, I would like to join CHI in its efforts to provide medical, psychological, emotional, and spiritual support to children with life-threatening conditions, their families, and their health care providers, by becoming an:
_____ Individual/Professional Member 125 USD
10% discount on CHI publications; advance notice on new CHI publications; registration fee discount and advance notification of CHI international conference.
______ Institutional Member 750 USD
Allows all employees of member institution to receive 10% discount on CHI publications and a discount on registration fee for CHI international conference. Institution receives a copy of CHI newsletter.
Contact Person: ____________________________________
Title: _____________________________________________
Organization: ______________________________________
Address: __________________________________________
City: ______________ State: _____ Zip: ________________
Country: _________________ Postal Code: ______________
Home Phone: ______________________________________
Work Phone: _______________________________________
Fax Number: _______________________________________
E-mail Address: _____________________________________
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To pay by credit card:
Directions for use
- Click on “Program Area”
- Select MEMBERSHIP; click on appropriate level of membership
- Complete rest of form
Or mail payment in USD, along with this form to:
1800 Diagonal Road, Suite 600
Alexandria, VA 22314
Upload Membership Application:
