AALAS Individual Membership Application Form

Membership is for 12 months following receipt of payment. Membership in an AALAS Branch is not membership in national AALAS.

1
Please check: Mr. Ms. Dr. Check one: NEW RENEWAL (Membership # ________________________________ )

First Name ________________________________ Middle Initial ______ Last Name_______________________________________

Job Title ___________________________________________________________________________________________________
Company Name ___________________________________________________Department ________________________________
Business Address (will appear in Reference Directory) _______________________________________________________________________
City________________________________ State __________ Zip ________________ Country _____________________________
Business Phone (_________________________________
) ( )
Business Fax _________________________________________________
Email ______________________________________________
Occasionally we make our mailing list available to AALAS’ affiliated credit card company, MBNA, and to AALAS Commercial Members who offer
products and/or promotions that may be of interest to you. If you prefer NOT to receive such mailings, please check the following box:

Where would you like your publications and election ballot sent: Same address as above Please send to this address

2 Address __________________________________________________________________Phone ___________________________

City_________________________________________________________State_____________ Zip__________________________

3 Choose a membership level:

GOLD Domestic / $180
Benefits and Services of Gold, Silver, and Bronze AALAS Membership Levels
1. Voting privileges
BRONZE MEMBERSHIP

Canada or Mexico / $195 2. A $50 discount for National Meeting registration

International / $220 3. Reduced fees for technician certification exams—all levels
SILVER MEMBERSHIP

4. AALAS Certification Registry

GOLD MEMBERSHIP

SILVER Domestic / $85 5. Discounts on other educational materials

Canada or Mexico / $95 6. Access to members-only sections of the AALAS website
International / $115 7. Tech Talk newsletter—print and online versions
8. National Meeting Preliminary Program
BRONZE Domestic / $35
9. AALAS in Action newsletter—print and online versions
Canada or Mexico / $40
International / $45 10. Subscription to JAALAS—print and online versions
11. AALAS Reference Directory
Amount of membership dues applied to publications:
Comparative Medicine: $110.88 12. Subscription to Comparative Medicine—print and online versions
JAALAS: $56.42
Tech Talk/AALAS in Action: $10.11
13. AALAS Leadership & Committee Resource Directory

4 Method of Payment:
Check (Number: ________) Money Order VISA American Express MasterCard
Month Year
Discover

Account Number—please include all digits Expiration Date CVV2 Code (3 or 4 digit # on back of
credit card. Required for processing.)

Amount Enclosed: Dues $ _______________ Foundation donation $ _____________ TOTAL ENCLOSED $ ______________
Cardholder name: _______________________________________________
(print name exactly as it appears on card)
Cardholder phone number: _______________________________________
If you wish to make a tax-deductible contribution to the AALAS
Billing address: __________________________________________________ Foundation, please complete this section.

_______________________________________________________________ I have enclosed a one-time contribution to the AALAS Foundation

of __________.
City: ________________________________State: ______ Zip: ____________ Please send me information about making an annual contribution
to the Foundation.
Country: _______________________________________________________

Signature: ______________________________________________________
Make checks payable to: AALAS. Payments from Canada, Mexico, and international countries must be paid in USA dollars and issued from a USA bank. Call for details on wire transfers/EFT.
Payment Must Accompany Application. There is a $25 fee to change payment method and for returned checks. No cancellations or refunds on memberships.

Updated 10/07
5 Branch Membership: List the AALAS Branch to which you belong (if any). If you belong to more than one, list primary branch first.
______________________________________________________________________________________________________

Education/Workplace Information:
6 List your degrees
High Sch / GED
AS / AA
Area of employment
Teaching/Training
Commercial
Type of facility
College/University/Medical School
Pharmaceutical Co.
Research Government/ Military Research
BA / BS
Administration Other Industrial Co.
MA / MS
Animal Care Veterinary School
PhD
Medical Research Hospital
DVM
Other____________ Private Research
Other______________
Commercial Breeder
Other______________
Other____________

7 Application Sponsor: All new applicants are required to have at least one current National AALAS Member’s signature. Contact Member
Services at the AALAS office if this is a problem.
Sponsor Name ____________________________________________________ Membership Number_________________________
Signature __________________________________________________________________________________________________

8 I hereby apply for Individual Membership in the American Association for Laboratory Animal Science.

Signature _________________________________________________________________ Date_____________________________

Your application constitutes consent to receive email, mail, and faxes from AALAS.

9 Return This Application to:

AALAS
9190 Crestwyn Hills Drive
Memphis, TN 38125-8538
(901) 754-8620
fax (901) 753-0046

Updated 10/07