Individual Membership Application

INDIVIDUAL INFORMATION

Membership Level:

Professional - $150

Ad2 - $90

Educator - $65

Student - $20

Prefix: First Name: Middle/Initial: Last Name: Suffix: Company Name: Job Title: Email: Primary Phone: Secondary Phone: Fax: Address Type: Address: City: State: Zip: - Website:

FOR AAF STATISTICAL PURPOSES ONLY

Birth Date (MM/DD/YYYY) (this field is required for Ad 2 membership): / / Age Group Gender:

Male

Female

Self-Identify Below

Prefer not to disclose

Specify Self-Identified Gender: Race and Ethnicity:

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

White or Caucasian

Self-Identify Below

Prefer not to disclose

Specify Self-Identified Race and Ethnicity:

SOCIAL PROFILES

LinkedIn: Facebook: Twitter: Instagram:

ACCOUNT INFORMATION

To manage your AAF-Louisville account (i.e., register for events, update profile, renew membership, etc.), please create a login name and password below. Your password must be at least eight characters long, and contain at least one number.

Create a Login Name: Password: Retype Password:

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