Membership Form

 

Individual Membership / Corporate  Membership

 

Please fill in the membership application form. All required fields are marked with *.

Personal Information
Salutation Preference:   Mr.    Ms.    Mrs.    Dr.    Other: 
First Name: *   M.I.  Organization:
Last Name: * Title/Position:
 
Contact Information
*  Home    Work
Street Address *
Email address:

While not required, providing your email address will ensure timely delivery of member-only announcements.
City: * Phone: * x
State & Zip: *   Fax:
 
Business Information
Business Address
Website:
City: Phone:   x
State & Zip:   Fax:
 
Interests & Membership Information
* Membership Level
Individual Membership *:
 Individual / $50
 Envoy / $250
 Consular / $500
 Diplomat / $1,000

For Corporate Membership levels, click here.
 

* Student Membership: Student memberships are available at a discounted rate.
If you are a full-time student and interested in joining, please contact us by phone, (502) 561-5422.
 
* Payment Options:
 Bill me
 I will pay with credit card online  Accepted credit cards
Online Payments
 
Comments:

Please provide any information that will help us understand your membership interests. E.g., foreign languages you speak, countries in which you have a particular interest, activities you would like to participate (interpreting, hospitality, etc.):
* Anti-SPAM validation number:
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