AASSA Supporting Partner

Application

* Required

Thank you for your interest in becoming a Supporting Partner of AASSA. We look forward to working together and thank you for your support of our organization and our region.

Instructions:Please complete the form below and Submit. Upon receipt of your application, we will review your application and if approved we will invoice you for the annual membership fee which covers membership for the academic year from July 1 through June 30.

Part I. Information About Your Organization

Name of Organization:required

Name of Representative:

Prefix
Firstrequired
Middle
Lastrequired
Suffix

Mailing Address:

Address 1required
Address 2
Address 3
Cityrequired
Staterequired
Region
Zip Coderequired (ex. 06108 or 06108-0809)
Country

Phone
Ext

Email Address:required

Organization's Website:required

Part 2: Membership Level

Please select your desired membership level.

Supporting Partnership Level:*

Silver Partner $1,250 Gold Partner $2,500 Platinum Partner $5,000

If you have any questions regarding membership, please do not hesitate to contact the AASSA office.

Thank you again for becoming a Supporting Partner of AASSA.

Please send a confirmation email to the address below*: