Transcription of AGA Membership Application
1 AGA Membership Application I. Membership Data/Dues Please choose a Membership category and fill in the appropriate dues from the list on the back of this Application . By joining, you allow AGA to contact you via email regarding member-related activities. o Full Government $100/year This class of Membership is available to individuals currently working in government, academia and not-for-profit organizations. o Private Sector $160/year This class of Membership is available to sole proprietors and those working for private companies, corporations or partnerships. o Early Career $45/year This class of Membership is available to individuals with fewer than three years of professional experience who work in private or public sector. o Student (full-time) $30/year This class of Membership is available to full-time college/university students who are not gainfully employed. Primary Chapter Dues Additional Chapter Membership (s) Optional Dues (please refer to list on the reverse side).
2 II. Name & Home Address o Mr. o Mrs. o Ms. o Dr. o Prof. | o male o female Preferred Address: o Home o Business Name FIRST MIDDLE LAST Home Address Apt/Suite# City State/Province ZIP Code Country Home Phone Home Email III. Business Information Job Title Dept. Organization Business Address Apt/Suite# City State/Province ZIP Code Country Business Phone Business Email Employer: o Federal o State o County o City o Nonprofit o Private o Academia o Student Responsibility Area: o Academia o Accounting o Administration o Auditing o Budgeting o Consulting o Financial Management o Grants Management o Information Systems o Investigation o Legal o Management/Admin. o Other o Performance Mgt. o Program Mgt. How did you hear about AGA? o AGA Chapter o AGA Conference o AGA Email o AGA Publication o CGFM Program o Direct Mail o Employer o Friend/Co-Worker o Internet o Non AGA Conference Age: o < 21 o 21 25 o 26 30 o 31 35 o 36 40 o 41 45 o 46 50 o 51 55 o 56 60 o 61 65 o 66+.
3 Highest degree attained: o Associate o Bachelor's o Law/Judicial o Master's o Doctorate Certifications: IV. Sponsor's Name (if applicable) Member ID #. V. Method of Payment 2208 Mount Vernon Avenue Total Amount Enclosed: Alexandria, VA 22301. o Check enclosed Charge to my: o VISA o MasterCard o American Express o Discover (make check payable to AGA) Card Number Expiration Date Signature Printed Name Annual Chapter Dues Table F = Full Government Member CHAPTER F/P E S CHAPTER F/P E S CHAPTER F/P E S. P = Private Sector Member E = Early Career Member IOWA NEW MEXICO WASHINGTON. S = Student Member Des Moines Albuquerque Central Washington CHAPTER F/P E S New Mexico Northwest Inland -0- -0- -0- JAPAN Empire ALABAMA Japan NEW YORK Olympia New York City Seattle Montgomery KANSAS New York Capital -0- -0- -0- Northern Alabama Topeka -0- -0- -0- Rome -0- -0- -0- WEST VIRGINIA. ARIZONA Charleston KENTUCKY NORTH CAROLINA.
4 Phoenix Mid-Ohio Valley Central Kentucky North Carolina Southern Arizona Triangle WISCONSIN. LOUISIANA. ARKANSAS Southern Wisconsin -0- -0- -0- Baton Rouge NORTHERN MARIANA. Central Arkansas New Orleans ISLANDS STUDENT AFFILIATE. Northern Mariana -0- -0- -0- CHAPTER. CALIFORNIA MAINE Islands Old Dominion N/A N/A -0- Central Coast Aroostook County University Inland Empire of CA Maine OHIO Indiana University N/A N/A -0- Los Angeles Cincinnati 1. State and Local Focus Los Angeles Civic MARYLAND Cleveland 2. Federal Focus Center Baltimore Central Ohio1 Silicon Valley Montgomery/ -0- Greater Columbus2 -0- -0- -0- Sacramento Prince Georges Please call AGA's Customer Satisfaction OKLAHOMA Center at if you do not San Diego MASSACHUSETTS see a chapter listed in your area. San Francisco Oklahoma City Boston *Dues subject to change without notice. COLORADO OREGON. MEXICO Updated August 2015. Denver Mid-Willamette Valley -0- -0- -0- Mexico City -0- -0- -0- Portland CONNECTICUT.
5 Hartford -0- -0- -0- MICHIGAN PENNSYLVANIA. Detroit Central Pennsylvania DELAWARE Greater Lansing Philadelphia -0- Dover Capital West Michigan PUERTO RICO. DISTRICT OF COLUMBIA MINNESOTA Puerto Rico -0- -0- -0- Washington, DC Minneapolis/St. Paul -0- -0- -0- SOUTH CAROLINA. FLORIDA MISSISSIPPI Charleston Naples Paradise Gulf Coast -0- -0- -0- Southeastern Florida -0- -0- -0- SOUTH DAKOTA. Jackson Tallahassee South Dakota West Central Mississippi GEORGIA TENNESSEE. Atlanta MISSOURI Chattanooga -0- Coastal Georgia Kansas City -0- -0- -0- East Tennessee Mid-Missouri -0- -0- -0- Nashville GUAM St. Louis -0- -0- -0- TEXAS. Guam The Ozarks Austin HAWAII MONTANA Dallas Hawaii -0- Missouri River -0 -0- -0- El Paso -0- -0- -0- Houston IDAHO NEBRASKA San Antonio Idaho Centennial -0- -0- -0- Lincoln -0- -0- -0- Omaha Metro Area UTAH. ILLINOIS Northern Utah Chicago NEVADA. Springfield Northern Nevada -0- -0- -0- VIRGINIA.
6 Northern Virginia INDIANA NEW JERSEY Richmond Central Indiana1 Northern New Jersey -0- -0- Roanoke Circle City Trenton Shenandoah Valley -0- -0- Indianapolis2 Virginia Peninsula -0- -0- -0.
