866-425-3678 office@theial.com

Associate Membership Application

Associate Membership Application

Application for Associate Membership

The information provided below will be listed in the IAL Directory, and will determine where IAL correspondences will be sent. Please print or type.
Company or Organization Name ______________________________________________

Mailing Address ___________________________________________________________

City ____________________________________________________________________

State _____ Zip ______________

Telephone ___ – ___ – ______

Email ________________________________

An Associate Membership is designed for suppliers, manufacturers, health care organizations and service companies who provide medical support to laryngectomees. These members have no voting rights but may participate as committee members if requested. Dues will be determined by a recommendation from the Bylaws Committee to the Board of Directors. In no case will the dues be less than that of the largest IAL Club.

 

If you have any questions:

Telephone: 866-425-3678

Email:  ialed@theial.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it

 

Signed: _____________________________________________  Date ___ /___ /_____

Please sign and mail your minimum payment of $175.00 to the address below:

The IAL
925B Peachtree St. NE, Suite 316
Atlanta, GA 30309

 


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