Affiliate Membership Application

Professional affiliate membership application

I, the undersigned, hereby apply for admission to the Professional Affiliateship in the American Institute of Architects Central Kentucky Chapter (AIA-CKC).

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Name *

First

Last

Profession *

Title *

Firm *

Address *

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City

State

Zip Code

Country

Phone Number *

Email *

If you are licensed or registered to practice your profession, provide below the state(s) and name(s) under which you are titled:

Professional License(s) & State(s) Issued *

I declare that the above information is accurate and complete. I understand that as a Professional Affiliate member, I will be subject to the duties, obligations and responsibilities set forth in the relevant portions of the AIA/CKC Bylaws. I enclose my check for the admission fee and the first year’s annual dues and programs.
I understand that if I am not admitted to membership, this payment will be returned to me.

I am interested in being contacted about the following sponsorship opportunities: *

Event Flyer Website Other

ATTENTION - PAYMENT INSTRUCTIONS:
Please remit payment by check to the “AIA/Central Kentucky Chapter” and mail to:
AIA/Central Kentucky Chapter
P.O. Box 9051
Louisville, KY 40209

Fees:

Application Fee [first year only] $30.00
Annual Dues $30.00
Program Fee $30.00

Total: $90.00

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