Queen City 5k Sponsorship Form

Allied Membership Payment Form

Thank you for your interest in becoming an Allied Member of AIA Buffalo/WNY! You can use this form to submit your payment online. If you have questions, please click here to contact us and we'll be happy to help you.

Your Information

Name*

First NameLast Name

Contact Email*

You'll receive the course link at this email address.

Telephone*

Company Name

Payment

Please choose your Allied Membership or Sponsorship option below.*

Allied Membership - Individual$250.00

Allied Membership - Business or A/E Firm Partner$600.00

Allied Membership - Business Mid Year$250.00

Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Note: Please do not click the "Pay Now" button more than once.
Reach out to Rob Szudzik with questions about the payment process.