Regular Membership Application Form

Print this page, complete the application, and submit it -- along with (1) a current copy of your curriculum vitae including bibliography, and (2) a copy of the title page of a first-author publication that meets the criteria -- to:

Chair of the AAI Membership Committee
9650 Rockville Pike
Bethesda, MD 20814-3994

Name: _______________________________________________________

Please state type of Degree(s)
and Date(s)Received:_________________________________________

Institution: ________________________________________________

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Publication: ________________________________________________

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Current Title/Position:______________________________________

Address: ____________________________________________________

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Street: _____________________________________________________

City: ____________________ State: _____ Zip Code: ___________

Email address: _____________________________________________

Phone #:(____)______________ Facsimile #:(____)______________

Specialties: _______________________________________________

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Professional Activities: ____________________________________

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Reference: __________________________________________________
            Name of AAI Member (Please Print Clearly) 

Signature of AAI Member: ____________________________________

Application Review Deadlines
Applications are to be received in the AAI Office by the first day of each month.