2011 AEMS Dues Membership Application Online
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1. 2010 AEMS Dues Membership Application

Thank you for applying online to become an AEMS Dues Paying Member. Please complete the application below.

This year AEMS offers a convenient option for paying membership dues, through PayPal online. (Note: an online processing fee is included in the dues payment).

You may choose to pay your dues on an annual basis OR for two years (discount provided) – see details below.

Once your application is processed, we will issue you a confirmation letter and receipt.

Thank you for your support of and involvement with AEMS!

If you should have any questions, or encounter any problems with completing this application, please contact:

AEMS
Peggy Baker
pbaker@aems.org
623-847-4100

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Please note: Questions marked with an asterisk (*) must be completed to submit application.

*
1. Name of Organization

Name of Organization

2. Contact Person:

Contact Person:

*
3. Complete Mailing Address - Street/PO Box, City, State, & Zip:

Complete Mailing Address - Street/PO Box, City, State, & Zip:

*
4. Day Phone - include area code:

Day Phone - include area code:

5. Fax:

Fax:

*
6. Email:

Email:

7. As an organizational member, you are entitled to appoint five individuals, who are members of your organization, to represent you as an AEMS member. The above contact person should appear first.

As an organizational member, you are entitled to appoint five individuals, who are members of your organization, to represent you as an AEMS member. The above contact person should appear first.

*
8. Name on Credit Card

Upon completion of this registration form, you will be redirected to the PayPal link where you will remit credit payment. However, we request the name on your credit card so that we may cross reference your registration with your PayPal payment.

Name on Credit Card Upon completion of this registration form, you will be redirected to the PayPal link where you will remit credit payment. However, we request the name on your credit card so that we may cross reference your registration with your PayPal payment.

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Thank you for completing the 2011 AEMS Dues Membership application online. Click "Done" and you will be redirected to the PayPal link where you will remit your credit card payment. Once payment is received, we will issue you a receipt.

Thank You for your support of AEMS!
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2011 AEMS Dues Membership Application Online Exit this survey >>

1. 2010 AEMS Dues Membership Application

*1. Name of Organization

2. Contact Person:

*3. Complete Mailing Address - Street/PO Box, City, State, & Zip:

*4. Day Phone - include area code: