Michigan AALAS Membership

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New Member

Current Member

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)

Alternate Mailing Address:

City:

Zip:

State:

Membership Options:

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

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

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.

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 Individual Membership Application

Company:

Member Name:

REQUIRED

Phone:

REQUIRED

Fax:

Member Information:

Current Membership Status:

Credentials:

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

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.

Return to Membership Selection Page

View Michigan AALAS Website Privacy Policy

After submitting your application, click on
the PayPal icon to send the payment and
complete the application process.

$15.00