New Membership.

Date

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Name *

First Name Last Name

E-mail

Phone Number *

Area Code Phone Number

Address *

Street Address
Steet Address Line 2
City	State
Zip Code	Country

Please select:

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Each year we produce a membership directory which is distributed ONLY to IAHF members. Inclusion of your name, phone number and email address is automatic. We never publish your street address. If you would like to be excluded, or have some of your information excluded, please indicate below:

Exclude ALL my information Exclude my phone number Exclude my email address

If this is a Family or Patron Membership, please enter 2nd name here:

First Name Last Name

Choose Membership Level

Individual Membership $ 50.00

Family Membership $ 60.00

Patron Membership $ 150.00

Business Membership $ 125.00

Student Membership $ 20.00

Total $ 0.00

Payment Method

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

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