Associate To Architect Form - 2017
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1____________________________
Date
____________________________
Member ID
2017 Associate to Architect Form
Please indicate the jurisdiction in which you are licensed to practice in the United States (To avoid processing delays, you must include a copy of your current U.S. license.).
Upon verification of your active U.S. license, your membership type will be changed to Architect.
Personal Information
First
M.I.
Last
Address
Apartment/Unit #
City
State/Country
ZIP
Home Phone
Home E-mail
Home Fax
Cell Phone
DOB*
*Your birth date enables the AIA Trust to issue new architect members a $15,000 life insurance policy premium free for one year.
Company Information
Company Name
Job Title
Address
Suite/Floor
City
State/Country
ZIP
Office Phone
Office E-mail
Company Web
Office Fax
Address
Office
Mailing Preference:
Home
Office
Primary Email:
Home
Office
Primary Phone:
Home
License Information
Your license must be active at the time of submission of this form.
State
Date Awarded
Expiration Date
License Number
State
Date Awarded
Expiration Date
License Number
An Associate member that changes to Architect status is not liable for Architect dues until the following renewal year.
Are you a member of any of the following professional organizations?
GBCI LEED AP # ____________________________
USGBC National Member (Company)
USGBC Local Member (Individual)
Type of firm/company with which you are
currently employed:
Architecture – sole practitioner
Interior design
Project manager
Architecture firm
Landscape
Engineer
Multidisciplinary design firm/architecture
Urban design
Interior designer
as lead
University/college
Graphic designer
Multidisciplinary design firm/architecture
Library or association
Construction administrator
not lead
Other __________________
Specification writer
Corporate business
Primary role in firm/company
CAD manager
Government agency
Principal/partner
Architectural drafter
Construction
Architect
Other __________________
Please return by mail, fax, or e-mail: The American Institute of Architects, P.O. Box 64185, Baltimore, MD 21264-4185
E-mail to:
| Fax to: (202) 626-7547
Questions? Please contact AIA Information Central at 1 (800) 242-3837, option 2
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