ACTLA Membership Payment Invoice Request
Once this request is received and processed, you will be mailed a PayPal invoice that will allow you to pay by credit/debit card.

Revised 10/21/2020
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01. First Name
02. Last Name
03. Email
04. Institution
05. State (2-Letter Abbreviation)
06. Membership Type
Clear selection
07. Payment Method
Clear selection
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