Membership Renewal

MEMBERSHIP RENEWAL

Dues must be paid by APRIL 15th to maintain your membership in good standing. Dues paid after April 15 should include a $5 late fee.

* Indicates required field

First name *

Last name *

E-mail *

RMDIAI member number *

Any changes since last renewal? *

Yes (Update in the fields below and submit) No (skip to bottom and submit)

Employer *

Work address (Street, city, state, zip) *

job title *

Work phone *

Home address (street, city, state, zip) *

Home phone *

Professional Certifications earned since last renewal *

Professional certifications lapsed since last renewal *

Have you become an IAI member since last renewal? *

Yes No

If "Yes", please indicate IAI member number: *

Changes to mailing preference *

Home Address Work Address

Changes to directory publication *

Home Address Work Address

Comments *

Submit