Please provide the following information to register for membership (*required):
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Home Address*
Home Address2
Home City*
Home State	ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING ALBERTA BRITISH COLUMBIA MANITOBA NEW BRUNSWICK NEWFOUNDLAND NORTHWEST TERRITORIES NOVA SCOTIA NUNAVUT ONTARIO PRINCE EDWARD ISLAND QUEBEC SASKATCHEWAN YUKON UNITED KINGDOM GREAT BRITTAN NEW SOUTH WALES VICTORIA QUEENSLAND SOUTH AUSTRALIA WESTERN AUSTRALIA TASMANIA NORTHERN TERRITORY Areas not listed should leave blank and enter City and State above.
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WORK:
Government or Military*	Non-Government Government Military
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Work Address
Work Address2
Work City
Work State	ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING ALBERTA BRITISH COLUMBIA MANITOBA NEW BRUNSWICK NEWFOUNDLAND NORTHWEST TERRITORIES NOVA SCOTIA NUNAVUT ONTARIO PRINCE EDWARD ISLAND QUEBEC SASKATCHEWAN YUKON UNITED KINGDOM GREAT BRITTAN NEW SOUTH WALES VICTORIA QUEENSLAND SOUTH AUSTRALIA WESTERN AUSTRALIA TASMANIA NORTHERN TERRITORY Areas not listed should leave blank and enter City and State above.
Work Zip Code
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CHAPTER AND PAYMENT INFORMATION:
Chapter Preference	At Large Members Certified Non-Member Atlanta St. Louis Gateway Greater Dayton Central Florida Greater Alabama New England Pike's Peak Southern Maryland Rocky Mountain Southern California San Diego Houston/Clear Lake Northwest/Washington Northwest Florida Washington Metro (Optional )
Payment Type*     (Online method is preferred)	Online (Credit Card) Mail-in/Fax (Check)
Amount	55.00 (Annual Membership) 550.00 (Lifetime Membership)