AHAA Fact Sheet | AHAA Goals & Objectives

Please select the membership category that you want to join under:

If you have any questions about our membership categories, please contact AHAA headquarters.

The Prospective Member intends to join AHAA in the

membership category and agree to annual dues of
$ (per calendar year)

Method of Payment:

Check

Credit Card:       American Express  MasterCard        Visa

Account Number:

Name on Credit Card:

Expiration Date:

Signature:__________________________________________

Payments to AHAA are not tax deductible as charitable
contributions for federal income tax purposes. However,
they may be deductible as ordinary and necessary
business expenses. AHAA's Federal Tax ID is 75-2659688.

Agency/Company Profile

All prospective members must fill out this profile. If you are applying as an Associate Member, complete only the information that applies to your company. Prospective General Members must provide two references of existing AHAA members, two vendor references, and credentials of agency principals with this application. AHAA reserves the right to reassign a prospective member to another category.

Agency/Company Name:
Address:

City: State: Zip Code:

Phone: Fax:

Date Founded: Website:

Key Contact (Voting Representative for General Members):

Name:
Title:
E-mail:

Other Full Service Office Locations:

1. City: State:
Contact:
Phone:

2. City: State:
Contact:
Phone:

3. City: State:
Contact:
Phone:

National Agency Association/Ownership:

Percentage Minority Owned: %
Parent Company (if any): %

Previous Year Capitalized Billings:

Percentage of Hispanic Business: %
Percentage Non Hispanic: %

Total Number of Employees:
Percentage of Hispanic Employees: %

Major Accounts:

1. Client Since:

2. Client Since:

3. Client Since:

4. Client Since:

5. Client Since:

6. Client Since:

Key Agency/Company Personnel:

1. Name:
Title:

2. Name:
Title:

3. Name:
Title:

4. Name:
Title:

5. Name:  
Title:

Please print form and fax to AHAA headquarters at (703) 610-9005.