Michigan AALAS Membership

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Address:

REQUIRED

City:

Zip:

State:

ALAT

LAT

LATG

CMAR

AALAS Certification Level:

LVT

DVM

ACLAM

Yes

No (if no, please provide an alternate delivery address below)

Training Others

Monetary Donation

Participation on a committee

Equipment or supplies donation

Would you be interested in assisting MI-AALAS in any of the following ways?
(Check all that apply)

Yes

Newsletter Business Card Ad *

Newsletter Quarter Page Ad *

Web Page Business Card Ad **

By checking this box, applicant agrees to the stipulations specified in the Michigan AALAS website privacy policy. Applicant also agrees to pay the amount shown in order to obtain the membership. This application is not valid without full payment of membership fee.

Alternate Mailing Address:

City:

Zip:

State:

Membership Options:

Do you want the AALAS Newsletter and other AALAS correspondence mailed to the
address above?

REQUIRED

Fill in the information below and click on the SUBMIT button. Click the RESET button to clear
all information from the form. Required fields are marked in red.

Michigan Branch AALAS Business Membership Application

Business Name:

Contact Name:

REQUIRED

Phone:

REQUIRED

Fax:

Business Name and Address:

Credentials:

May we include your name and information in our website directory (accessible by
members only)?

Contact Information:

E-Mail Address:

Advertising Fees:

$75.00 per year

$125.00 per year

$40.00 per year

** Contact Kelly Jimenez at 517-353-3256 or e-mail hillkell@ora.msu.eduu with questions about web ads.

Online AALAS Membership Application

To apply online, fill out the form below and click SUBMIT. Payment
must be made through PayPal. After submitting your application click
on the PayPal icon to complete membership payment.

Before submitting your application, click on the corresponding PayPal icon to send the payment
for the appropriate amount. A separate PayPal window will appear. Complete the payment and
close the PayPal window, then submit your application.

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View Michigan AALAS Website Privacy Policy