http://www.aiamadison.com
2011 MEMBERSHIP FORM
__Individual ($10 )
__Annual ($20/Family) __Life Membership ($300 – Individual/ Family)
Check #_______________________
Cash________
MEMBER NUMBER: _________________
Please Print:
Last Name__________________________________
First Name____________________________________
Spouse: Last Name _________________________
First Name_____________________________________
Children’s Names _______________________________________________________________________________
Address___________________________________________________________________________________________
E-Mail Address______________________________________________ Telephone _______________________________
SEASON TICKET DETAILS
ADULT
KIDS
x $ 22=
X $ 12=
Ticket Totals
MEM DUES
Payment Totals
$ 20 or $10
ADULTS (Name and Serial #)
KIDS (Name and Serial #)
1
2
3
4
5
6
1
2
3
4
5
6
Sponsor Mother’s Day/Grad Banquet
 $100+ --------
$300+--------
 $500+--------
 $1000+--------
 $2000 +----------
 Other $-----------
All sponsors will be given recognition at the event and all donations are tax deductable
Make all checks payable to AIA – Madison (Membership Forms are available at www.aiamadison.com)
Mail your totals to : AIA-Madison, P.O. Box 45532, Madison, WI 53744-5532