A-IAC MEMBERSHIP FORM (2022)
ALL INFORMATION IS PRIVY TO BOARD MEMBERS ONLY

COMPLIMENTARY MEMBERSHIP: Age 90+ & Under 17
NEW MEMBER / MEMBER RENEWAL: $25/- PER PERSON
Email *
FIRST NAME: *
LAST NAME *
DATE OF BIRTH
MM
/
DD
/
YYYY
DO I WANT MY BIRTHDAY PUBLISHED IN THE MONTHLY CARD SENT TO MEMBERS? *
DO YOU HAVE A PARTNER? *
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