AASSA Supporting Partner

Application

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 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:*

Name of Representative:

Prefix
First*
Middle
Last*
Suffix

Mailing Address:

Address 1*
Address 2
Address 3
City*
State*
Region
Zip Code* (ex. 06108 or 06108-0809)
Country

Phone
Ext

Email Address:*

Organization's Website:*

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*: