Member ID

*First Name

*Last Name

*Address

*City

*State

*Zip Code

*Rank

*Date of Birth

*Email

*Phone Number

*Member Type

*Member Term

*Billing Zip Code

*Credit Card Type

*Name on Card

*Card Number

AMEX enter '0' before card number

*Card Expiration

*Security Code

Visa/MC/Disc enter '0xxx' AMEX enter 'xxxx'

*Auto Renew

Yes, I authorize the AFSA HQ to auto renew my annual dues from the credit card number as listed above at the dues rate at the time of joining.

Retainer ID

Retainer's Chapter#