AHIA Corporate Platinum.
Membership Application.

Company Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Name *

First Name

Last Name

Address (If different from above )

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Country

(###)

###

####

Please indicate (by circling) if any of the following areas of interest to your company / business:

Guest Speaker(s)

Mentor/ Mentee

Volunteer(s)

Venue Host

Event Sponsor

Scholarship(s)

Exhibitor / Careers

Publications Feature(s)

Education

Other (please indicate):

Contact Name *

First Name

Last Name

Date

MM

DD

YYYY

AHIA website acknowledgement section; Other uses subject specific approval (i.e. Social Media Channels)

Format Provided

JPG

PNG

EPS

PDF

Logo type

Full Colour

Black and White

White

Communication Contact

First Name

Last Name

I hereby agree to the General Authority for Use - Member Logo / Branding, or by your conduct in providing your Corporate Brand ( including logos / imagery) to AHIA for any of the uses described above, you are providing your acknowledgement and agreement to the terms above.