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Online AIRA Membership Renewal Form

Member Info:
Last Name
First Name:
Are you CIRA?
Middle Initial:
Email Address:
Confirm email:
Company Name:
Position:
Business Address:
 
City:
 State:

Zipcode:
 Country:
Business Phone:
Alt. Phone:
FAX:
Alt. Email:
 

Amount to Pay:
$225.00
 Regular Annual Membership
$75.00
 Government/Education Annual Membership
$300.00
 CIRA Annual Membership (CIRAs must choose this option.)
  Other (Specify):
Payment Method:
Amex Visa MasterCard Discover
Card Number:
 Exp. Date: /   (mm/yy format)
Name on Card:
Billing Zip Code:
 (The zipcode where you receive your credit card bill)
Comments or Special Instructions:

Submit Your Membership Renewal Payment:

If you prefer to renew by mail, you may download a printable renewal form HERE. Fill it out and mail it, with payment, 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

© 2006 AIRA, Inc. All Rights Reserved