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Membership
Academic Institutional Membership Form

The following individual is designated as the representative of the IAEE Academic Institutional Membership Program:

All fields with an "*" are required

NAME:*
TITLE:
COMPANY:
STREET ADDRESS 1:*
STREET ADDRESS 2:
CITY:*
STATE:*
POSTAL CODE:
If you do not have a postal code, please enter '12345'
COUNTRY:*
PHONE:
FAX:
EMAIL: *
USERNAME: *
PASSWORD: *
CONFIRM PASSWORD: *