AFFILIATE MEMBERSHIP APPLICATION

To request SPD Affiliate membership, please complete this form. It will be sent to the SPD Secretary for review. The Secretary will inform both you and the AAS of your membership approval. After approval, the membership department will charge your credit card if entered on this application. If remitting dues by check, the membership department will process your application upon receipt of dues.

PREFERRED NAME AND ADDRESS

First Name *

Middle Initial

Last Name *

Affiliation / Institution *

DIRECTORY ADDRESS

Enter your WORK address here. It will be listed in the online and/or print AAS Membership Directories only after you opt-in.

Street Address

Address Line 2

City

State/Province

Zip/Postal Code

Country

Phone Number

Primary Email Address *

HOME ADDRESS

Enter your HOME address here. This will be used to determine your congressional district if in the USA.

Street Address

Address Line 2

City

State/Province

Zip/Postal Code

Country

Home Phone or Cell Number

Alternate Email Address

Preferred Mailing Address 🛈

Directory Address

Home Address

Preferred Billing Address 🛈

Directory Address

Home Address