Individual Membership

To become an Individual Member of WNYCOSH or the Worker Center, please fill out the form below. You can pay dues online through our PayPal account. If you’d like to make you donation a recurring one, please use the Donate button here and note that in the form.

You can also download a membership form here.

Individual Membership

Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
Place of Employment
Occupation
Professional Discipline
Union Affiliation (if any)
Are you interested in any of the following?
- Teaching/Training
- Canvassing/Outreach
- Clerical/Office work (phone banking, mailings, etc.)
- Research on Safety & Health Issues
- Health & Safety Committee
Membership
Membership Type*
- Worker Center Member
- Individual Member
- Contributing Member
- Sustaining Member
Additional Information