Arkansas Association of Instructional Media Membership Information Form
Membership runs Conference to Conference

If you attended conference, your membership dues and information were collected at registration. You do not need to submit this form.

If you were unable to attend conference and simply want to renew your membership fill out this form.

If you are a new member, please use this form.
Email *
I will pay my membership dues by *
Step 1: Personal Information
First Name *
Last Name *
Home Address *
Street, Apt, Number, etc.
City *
Home Address City
State *
Home State
Zipcode
Home Zipcode
Personal Phone Number *
Company or School Name *
If you are a public school teacher, please include the district. Ex: Westside Elementary, Greenbrier) IF YOU ARE RETIRED, please put the word "RETIRED" in each of the blanks for this area.
Company or School Address
Street, Apt., Number, etc. IF YOU ARE RETIRED, please put the word "RETIRED" in each of the blanks for this area.
City *
IF YOU ARE RETIRED, please put the word "RETIRED" in each of the blanks for this area.
State *
IF YOU ARE RETIRED, please put the word "RETIRED" in each of the blanks for this area.
Zipcode *
IF YOU ARE RETIRED, please put the word "RETIRED" in each of the blanks for this area.
Company or School Phone *
IF YOU ARE RETIRED, please put the word "RETIRED" in each of the blanks for this area.
Preferred Email address for the listserve *
Alternate Email Address (optional)
I prefer to receive mailings from AAIM at my
Clear selection
Step 2: Membership Registration
I am registering for: *
If paying by Credit Card, please complete your membership by following the link below to AAIM Card Payment Page. https://gateway.clearent.net/paylink/000001380682/10019874
If paying by check, mail your payment to: Devona Pendergrass, 149 Brushy Knob Trail, Mountain Home, AR 72653
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