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AET Online Student Member Application

Membership Fee

Membership Type *

Student - $ 50.00

Please renew my membership automatically.

Total Amount

Personal Information

Prefix

First Name *

Middle Initial or Name

Last Name *

Suffix

Preferred Pronouns

Job Title

Contact Information:

Affiliation

Work Phone *

Work Fax

Home Phone

Email *

Street Address *

Street Address Line 2

City *

State *

Country *

Zip / Postal Code *

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Other Details

Proof of Enrolment *

(student body card or course enrollment)

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