2008 AAIPA Membership Application

Membership Information

  Name:  *^{First *Last}
*Mailing Address:
*City:  *State *Zip

*Is this your home or work address?

Preferred Phone Number

^{(Home)   (Work) (Ext.)}

Employer/Firm Name:
Position Title:   
*E-mail address:
*E-mail address must be provided for you to receive confirmation of your application

Select a committee you would like to be involved in (you may select more than one):

Events    Fund Raisers    Newsletter    Education    Membership    Scholarship    Finance

Note: One of the purposes and benefits of the AAIPA is the networking opportunities it provides for its members. Many of our members work in fields or have expertise in areas that could benefit other members in the organization. The AAIPA will maintain a database of its members with their field(s) of work and/or expertise.  By entering information in the "Yes" area below, you agree to have your information included in our database, and understand that your information could be disseminated to others. The AAIPA will not provide this information without your permission. 

*Please note: A yes or no answer is required below:
 
Yes, include me!
 
(Please include a brief description of your field of work and/or other area(s) of expertise) 

  No, I do not wish to be included in the AAIPA member database 

Please enter any other questions or comments you have below:

* Required Fields