Online Application

APPLY FOR NEW MEMBERSHIP

The following list shows the various types of APIC memberships and corresponding annual dues:

APIC Membership Services will receive and process this application once completed.

Type of Membership:

Prefix:

First Name:

Middle Initial:

Last Name:

Suffix:

Address Line 1:

Address Line 2:

City:

State/Province:

Zip or Postal Code:

Country (if not US):

Occupation:

For demographic purposes, the APIC needs your age group. This info is used internally by the APIC and will not be made available publicly.

Age Group:

CONTACT INFORMATION :

The APIC encourages you to provide a valid email address in order to communicate effectively with you.

Email Address:

Exclude email from showing in the roster:

Home Phone #:

Work Phone #:

Work Phone # Extension:

Work Fax #:

HOW DID YOU FIND OUT ABOUT THE APIC:

How did you become interested in the APIC?:

If you previously selected 'Family Relative" as the Membership Type, please provide the primary member's name and APIC# below:

Enter the member's name that got you interested:

What is their APIC # (if you know it):

PAYMENT INFORMATION:

Enter the Total Amount Submitted:

Select Method of Payment:

(make check payable to 'APIC' and mail to : APIC Member Services, Box 55, Avon, NY 14414)

Your membership application has been assigned an internal tracking number.

Please record this internal tracking number:

Click below to submit application. Please click ONLY ONCE, then wait a few moments for the confirmation window to appear.