AEEE Individual Membership Application

AEEE Individual / Professional Membership Application

Covers one (1) named individual. Membership is not official until payment is received.
Name*

First NameLast Name
Email*

Confirmation Emailexample@example.com
Institution*
Title
Program (please select all that apply):*

Educational Opportunity Center (EOC)Educational Talent Search (ETS)McNair Scholars (McNair)Student Support Services (SSS)Upward Bound (Classic)Upward Bound VeteransUpward Bound Math & ScienceTRIO Training Center / ProgramOther
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Work Number

Area CodePhone Number
Email (to whom the invoice and receipt will be sent)*

Confirmation Emailexample@example.com
What is your preferred payment method?*

Pay later via checkPay now via credit card

AEEE Individual / Professional Membership Application