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Application for Membership

Today's Date:

We hereby apply for membership in AIB with all rights and privileges of an active member.

We wish to help support the work of AIB by contributing the sum of US dollars per calendar year, based on the recommended guidelines. ($500 minimum to receive benefits.)

Information for membership listing:
Application Sent By

Company Name

Address


City

State / Province
ZIP / Postal Code
Country
Web Site Address

Primary contact's name and mailing address:

Title (Mr., Ms., Dr., or other)

Name

Position / Job Title

Company

Address


City
State / Province
ZIP / Postal Code
Country
Phone

Fax
EMail


Please complete area below of other company, plant, or subsidiary locations included in this contribution that should receive membership benefits. Only those listed will receive membership rates.


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