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The American Institute of ArchitectsAllied Membership Application for CA Chapters
2
nd
qtr 2010
Personal Information
(please print clearly)
 
Mr.
 
Mrs.
Ms. First Name M.I. Last NameJob TitleCompany/Firm Name Company AcronymOffice Address (include suite number) City State ZIPHome Address (include apt. number) City State ZIPMain Company Phone Company Web SiteDirect Office Phone Extension Fax Office E-mail
Preferred Address:
(check one)
 
Office
 
Home
Business Practice
(please check all that apply)
 
 
Architecture
 
 
Consulting
 
Engineering
 
Landscape Architecture
Interior Design
 
Contracting
 
Publishing
 
Product Manufacturing
 
Art
 
Planning
 
Graphic Design
 
Photography
 
Lighting
 
Roofing
 
Other _______________ 
 
Dues Enrollment
The AIA is a three-tiered organization, however Allied Membership is only required at the local level.
 
For more information about joining the state chapter, please contact the AIACC at 916-448-9082. For more information about joining the national chapter,please contact the AIA at 800-242-3837. Membership dues are calculated on a calendar year, January through December. Newmember dues are prorated quarterly.
Members with a “join date” between April 1 & June 30, 2010:
Allied Membership Dues
Local
$138.75
(+
optional
State membership @ $187.50) = $_________ totalPlease assign me to the following local AIA component:
AIA/Los Angeles Chapter 
 
Method of Payment
(Please submit full payment of your membership dues)
 
Check enclosed (payable to the American Institute of Architects)
 
Charge my
 
Visa
MasterCard
 
AmExCard number Expiration dateCardholderBilling ZIP codeSignature
Please return completed application and payment to Steve Tanner,AIA Los Angeles Chapter, 3780 Wilshire Blvd, Suite 800, Los Angeles CA 90010.
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