Entry Level Membership Registration

An asterisk (*) denotes a required field.

Part 1. Personal Information

Name*

Title*

Company/Station*

Address*

City*

State*

Zip*

Phone*

Fax (optional)

Email*

How did you hear about A.W.M.?
 Local Chapter Colleague National A.W.M. Other:

Part 2. Payment Information

 Pay with Credit / Debit Card Pay with Check

I hereby certify that the completed information above is true and correct and I understand that this membership is non-transferable, and is NOT REFUNDABLE.