The AFA Alliance

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AFA Alliance Membership

We are excited that you are considering Alliance membership! Please complete the registration form below.

Upon confimrmation of receipt of payment, you will receive an email containing your user name and password for connection to the Alliance AgriNetwork. If you have questions please contact AFA at (816) 472-4232.

AFA Alliance Member Registration Form

	Full Name:
	Preferred First Name:
	Birth Date:
	Spouse's Name:

	Home Address:
	Home City:
	Home State:
	Home Zip:
	Home Phone:
	Cell Phone:
	Personal Email:

	Business Name:
	Title:
	Business Address:
	Business City:
	Business State:
	Business Zip:
	Business Phone (General):
	Business Phone (Direct):
	Business Email:



Preferred Method of Correspondance

	My home address

	My work address



Preferred Method of Contact

	Contact me by personal email with conference call schedules or updates

	Contact me by business email with conference call schedules or updates

	Contact me at my home number with conference call schedules or updates

	Contact me using any of the above for conference call schedules or updates

	Other:



Education

	University:
	Degree:
	Graduate Year:

	University:
	Degree:
	Graduate Year:



Membership

	I would like to become an Alliance member. ($50 per member)

	I would like to renew my Alliance membership. ($50 per member)

	I would also like to make a contribution to the AFA Brian Perry Memorial Fund:

	$50 "For the Future"* $100 Other: $

	* $50 “For the Future”is an option to directly contribute to the Alliance fund to sponsor existing AFA student member (this amount is fully tax deductible).



Nomination(s)

	I would like to nominate the following people for Alliance consideration:

	First/Last Name:
	Email Address:

	First/Last Name:
	Email Address:

	First/Last Name:
	Email Address:

	First/Last Name:
	Email Address:



Preferred Method of Payment

	I would like to pay my membership fee online (MasterCard or Visa).

	Instructions: Click Here to open a new window, view our Privacy Policy and proceed to your secure transaction. Once the transaction is completed a payment confirmation will be sent to you and AFA. You will then need to return to this window to complete and submit your registration to AFA.

	I would like to pay my membership fee by check.

	I would like AFA to send an invoice to my preferred address above.

Member Benefits

Membership Form

Nominate Someone
for Membership

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