Mail to: 3104 E. Camelback Road, # 814 Phoenix, AZ

85016-4502

Membership Information:

Membership Fees:

Name: ______________ _____________

Individual Membership $ 35.00

Title: ___________________ __________

Student Membership ___ $ 17.50

Organization: ____________ _____ _____

_____________________________________

Address: ______________________ _ _ __

Programs _____

Membership _____

_____________________________________

Diversity _____

Membership _____

City: __________________________ ___

Speakers Bureau ____

Public Relations _____

State: ________ Zip: _______ _

Youth Conference____

Website _____

Professional Development ____

Telephone: ___________ ____________

Membership Status:

Fax: __________________________ ___

Membership Renewal (circle): Yes /No

New Membership (circle): Yes/ No

E-mail: _______________________ ____

Member of ACR? _____ Yes _____ No

By becoming a member of AACR, you agree to honor ACR Standards of Practice, available at www.acrnet.org, Arizona Chapter

Would you like your "Membership Information" posted on AACR’s website?

/   / Yes

/   / No

Yes No

____________________________________

Applicant’s Signature

__________________________________

Date