Before using this form for renewal, check your membership status,
click on membership, then click on the Associate Member button on the left,
to check if you have already paid. At the end of each month, an updated list
of associates in good standing is posted on the Associate Member list.
Please use the due postcard for renewal, it will be stamped paid and returned to you.

THE ALLIED ARTISTS OF AMERICA, INC.

ASSOCIATE MEMBERSHIP REGISTRATION
Fiscal year January 1st through December 31, 2010

Please Print Clearly

NAME: _____________________________________________________

ADDRESS: __________________________________________________

CITY: ________________________STATE: __________ZIP __________

PHONE#: ____________________ Renewal __________ New _________

EMAIL ADDRESS____________________________________________

SIGNATURE: ________________________________________________

 

Enclose $40.00 check for Annual Dues, payable to Allied Artists of America

MAIL THIS APPLICATION TO:

Lucille Berrill Paulsen
Chairperson, Associates
958 Cobb Road West
Water Mill, NY 11976