New Corporate Membership Form
      (Membership Dues $500.00)

 

contact information:
   
Company:
Member Contact:
Address:
Address2:
City:
State:            Postal Code:
Country:
Phone: Fax:
E-Mail:
Company Web address

List of key Products

   

Please send Electronic copy of your company’s logo in a gif, jpeg format and 300 KB or less to:
Angela Klink
(angela@avs.org)

   
please provide the following information:
   
Primary Chapter
Secondary Chapter
Divisions: Choose up to four


 

Technical Group:
Institution Type:        
Job Function:
Highest Level of Education
Highest Degree Earned: 
   
   
method of payment: (Membership Dues $500.00)
 
Check 
(Make payable to AVS in U.S. dollars and drawn on a U.S. bank,
AVS Tax ID No: 04-2392373
)

AMEX
  MasterCard    VISA     
Card Number
Cardholder Name
Expiration Date
CCID