Global Occupational Health Safety Security

And Environment Organization Membership Form

APPLICANT INFORMATION:

Name: roland t. mago Job title: safety officer

Company Address:

Home Address:

City: Province / State: Post Code: Country:

Email:

Education:

Phone: (with country code)

MEMBERSHIP INFORMATION:
 I confirm that I share the same aims as The  I confirm that I am willing to be a member of the
Org. org.
 I agree for my contact details to be shared with
 I agree to receive other information from
other Union members in the online Member
The Org. (conferences, courses etc.) by email
Directory
MEMBERSHIP CATEGORIES AND FEES:
Membership fee (**)
Select your Membership Category (please select
one) 1 year 2 years 3 years

Associate Membership 30$ 40$ 60$

Institution, Agency, Corporation, etc. 100 € 150 € 220 €

PROFESSIONAL EXPERTISE:
PLEASE specify your area of professional expertise.

This information will be entered into the Go hSSe orG “Professional Skills file,” which ServeS aS a pool
of information when a request for a consultant/Training /expertise in a specific area of the
profession is requested.
[ ] Construction Safety
[ ] General Industry Safety
[ ] Fire Safety
[ ] Safety/Loss Control
[ ] Public Safety/Health
[ ] Fleet Safety
[ ] Industrial Hygiene
[ ] Product Safety
[ ] Risk Management
[ ] HAZCOM / HAZMAT , HAZWOPER
[ ] Aviation Safety
[ ] Oil and Gas
Other:
[ ] Safety Practitioner
[ ] Trainer OSH Local
[ ] Trainer International OSH
[ ] Consultant
[ ] Training Center for local OSH Training course’S
[ ] Training Center for international training course’s

By submitting this application, you are accepting that GO HSSE Org. will use the information provided
to perform an independent verification of employer, credentials, etc.

Print this Membership form fill up, scan and send to gohsseorg@gmail.com along with your latest CV