MEMBERSHIP
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Affiliate Member
$
15.00
Affiliate Membership: Secured by partnerships, corporations, institutions or organizations. This membership is entitled to one vote. No member of an affiliate membership is entitled to hold office unless that individual is also an individual Member of the Association.
2024 ANDDA Gestational Calendar
$
12.00
Quantity
1
2
3
4
5
6
7
8
9
10
Subtotal
$
0.00
Shipping
$
0.00
Total
$
0.00
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Business / Association Name
*
Last Name, First Name
Contact Person
*
Spouse, Partner, Additional Household Member
Website address
*
N/A if no website
Email
*
example@example.com
Phone Number
*
COUNTRY
*
Please Select
USA
Canada
Address
*
Street Address
City
*
State
*
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
US Zip Code
*
0000 if 4 digit unknown
Province
*
AB
BC
MB
NB
NL
NT
NS
NU
ON
PE
QC
SK
YT
Canadian Zip Code
*
0000 if 4 digit unknown
Business/Association Logo for Website
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