AFFILIATE MEMBERSHIP APPLICATION

To request HAD Affiliate membership, please complete this form. It will be sent to the HAD Secretary for review. The HAD Secretary will inform both you and the AAS of your membership approval, whereupon you may proceed with the $20 dues payment. After approval, you will send payment directly to the AAS executive office in Washington, DC.

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