I/We would like to be admitted into the membership of
The Association of Indians in America.
A check for $__________ made payable to AIA, Inc. is enclosed.
| Name: | ______________________________ |
| Spouse: | ______________________________ |
| Address: | ______________________________ |
| ______________________________ | |
| City: | ______________________________ |
| State: | ______________________________ |
| ZIP: | ______________________________ |
| Home telephone: | ______________________________ |
| Business telephone: | ______________________________ | Home Fax: | ______________________________ | Business Fax: | ______________________________ | Home email: | ______________________________ | Business email: | ______________________________ | Annual Dues: | $30.00 | Life Membership: | $300.00 | Donation: | $_______ |
The Association of Indians in America
1625 Eagle Bend
Weston, Florida 33327