Please print this form and fax or mail to:
American Association for Laboratory Accreditation
5301 Buckeystown Pike, Ste 350
Frederick, MD 21704-8307
301-644-3248 

You may elect to pay for your membership by credit card or by or by wire transfer. Please contact Sandy Clabaugh (301 644 3209) for wire transfer information.

Complete Part I, Part II, and Part III 

FAX TO:   (301) 662 6756

Part I.  Please Complete All Requested Contact Information:
Title:
Last Name:	First Name:
Company:
Mailing Address:
City:	State/County/Province:
Postal Code:	Phone:
Fax:	E-mail:
Signature:	Date:

 

 

Part II.  Please Select One Membership Category:
___Individual - open to any individual person	(US $100.00/year, or $240.00 for three years)
___  Institutional - open to any professional or technical society, or educational institution.	(US $200.00/year, or $480.00 for three years))
___ Organizational - open to any corporation or trade association or division thereof.	(US $400.00/year , or $720.00 for three years))

 

Part III.  Please identify payment method and provide requested information:
___ Check	Check #:
	Check amount US $:
___ Charge to Visa or Mastercard	Enter Card #
	Security Code
	Enter Card Expiration Date:
	Cardholder Name:
	Signature:
___ Purchase Order Attached	Enter Purchase Order #:
	Purchase Order Amount US $:
___ Please Send Invoice
Please send membership form with payment of the invoice.