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Affiliate Application Form

Please fill out all of the fields on this form. Please mail a check in the amount of $95.00 to the following:

The American Institute of Architects
Eastern Illinois Chapter
P.O. Box 1476
Homewood, Illinois 60430

Please provide the following contact information for your business address:

Last Name:

First Name:

Middle Initial:

Business Title:

Business Name:

Business Address:

City:

State/Province:

Zip/Postal Code:

Country:

Business Phone Number and Area Code:

Business Fax Number and Area Code:

Business E-mail Address:

Business Weblink:

Please provide the following contact information for your home address:

Home Address:

City:

State/Province:

Zip/Postal Code:

Country:

Home Phone Number and Area Code:

Please answer the following:

Mail Should Be Sent To: Business Home

Do you hold a certificate of registration as an architect or license to practice architecture? Yes No

Do you declare that you will comply with the Bylaws and the Code of Ethics of the Eastern Illinois Chapter of the American Institute of Architects? Click here to view the AIA-EIC Bylaws. Click here to view the AIA-EIC Code of Ethics. Yes No