Application for Reciprocal Membership

Application for Reciprocal Membership

If you have any questions, please contact communications@aiact.org
Reciprocal Membership Dues: $285.00/yr.
Information of Payment listed on next page of form.

Fields marked with an (*) is required.

___________________________________________________

AIA members who hold a primary membership in another AIA chapter and wish to hold a secondary membership in AIA Connecticut may join as a Reciprocal member.
Name*

First NameLast Name
AIA Member #*
Primary AIA Chapter*
Personal Information
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Personal Email*
example@example.com
Work Information
Firm Name*
Firm Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone Number*
Please enter a valid phone number.
Work Email*
example@example.com
Primary email (to receive AIA CT emails)*

PersonalWork Email
Primary Address (to receive AIA CT mailings)*

PersonalWork Email
Method of Payment (please select one)*

CheckCredit Card

Payment Information
Paying by Check:

Make check for AIA Connecticut dues of $285.00 payable to “AIA Connecticut.”

Please include a printed copy of this form with your payment. A copy will be emailed to you once you complete the form.

Paying by Credit Card

Reciprocal Membership

$285.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country