AHBAI Associate Membership Application Form

Print out and complete this application form and return to AHBAI with a check for $750 for a one year Associate Membership. Applications cannot be processed without dues payment. (Dues are per company, limit two representatives).

Name:____________________________________________________________

Title:___________________________________________________________

Additional Representative:_______________________________________

Title:___________________________________________________________

Company:_________________________________________________________

Address:_________________________________________________________

City:______________________________ State:______ ZIP:____________

Phone:___________________________________________________________

Date of Application:_____________________________________________

Description of Business:_________________________________________

Please list AHBAI member companies with which you currently
do business:

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________


Return application and check for $750 made payable to AHBAI to:

AHBAI Headquarters 
P.O. Box 809134
Chicago, Illinois 60680-9134,
312/644-6610.

All applications are subject to Board of Directors approval.