AIRA Application

Online Application Form for AIRA Membership

Applicant Info
Last Name		First Name:
Email Address:		Confirm email:
Company Name:		Alt. email:
Current Position:		Nickname:
Business Address:
City:		State:
Zipcode:		Country:
Business Phone:		Cell Phone:
FAX:

Professional Certifications:
	CPA	Chartered Accountant
	CTP	CMA
	Public Accountant	CFA
	Attorney	Other:

Professional Memberships:
Name:		Dates:
Name:		Dates:
Name:		Dates:
Name:		Dates:

Choose Membership
$225.00		Regular Annual Membership: Financial Advisors, Accountants, Crisis Managers, Troubled Business Consultants, Loan Workout Specialists and Investment Bankers rendering services in the business turnaround, bankruptcy and insolvency field. Also, attorneys, trustees and other individuals whose professional practice involves insolvencies and reorganizations.
75.00		Government/Education Annual Membership: U.S. trustees, assistant U.S. trustees, bankruptcy attorneys in the U.S. Trustees Office, analysts, and other professionals; bankruptcy judges, clerks and other government employees; university and college professors and lecturers.

Payment:
	Visa/MasterCard		American Express
	Card Number:	- - -	Card Number:	- -
	Expiration Date:	(mm/yy format)	Expiration Date:	(mm/yy format)
	Billing Zip:		Billing Zip:

Comments or Special Instructions:

Submit Your Application:

By submitting this form, I certify that the information contained within is true and complete to the best of my knowledge, and that I have never been expelled from any professional organization which might have a bearing on this application.

If you would like to order by mail, you may fill this form out online, print it out, and mail it to:

AIRA
221 Stewart Avenue, Suite 207
Medford OR 97501

Or FAX to: 541-858-9187

Need Help? E-mail us or give us a call at: 541-858-1665