AAIHDS Membership Application

   

We encourage you to complete your online registration at this time.
Our site is protected by VeriSign, the industry leader in encryption.
Name:
Degree:
Title:
Company:
Address:
City, State, Zip:
Phone:
Fax:
Referred By:
Email:
Position:
Profile:
Other:
Year Organization Became Operational:
Setting:
Risk Contracts: Yes     No

Membership Type
 
  Individual Membership for $197
New                  Renew 

Group Membership for $750 - A Group includes 6 memberships - Saving over $400!
New Group       Renew Group
 

Payment Method:
 
 
Pay by Check:   Make check payable to AAIHDS - Check#:
When you provide a check as payment, you authorize us either to use information from your
check to make a one-time electronic fund transfer from your account or to process the payment
as a check transaction.  Print and mail this with check to the address at the bottom of the page.

 
Pay by Credit Card:   When you hit submit you will be sent to the page for payment by credit card.
If the cardholder name is different than applicant name above,
please enter cardholder name here:
 
A receipt will be sent when the credit card is charged
If mailing or faxing this to us
please have cardholder sign here:

 
Comments:  
 

Help us cut down spam.

Type the number 411 into
the following box (Required)

 

 

 


  For Additional Information

  AAIHDS
  4435 Waterfront Drive, Suite 101, P.O.Box 4913
  Glen Allen, Virginia 23058-4913

  Phone: (804)-747-5823
  Fax: (804)-747-5316
  email: renders@aaihds.org

  Federal I.D.# 54-1687681

  A nonprofit 501(c)6 association

  Membership dues are not deductible for federal income tax purposes but may be deductible as a business expense.
  Consult your tax advisor for more information.