AFCEA Corporate Membership Application

*Company Name
Website
*POC First Name
*POC Last Name
*POC Email Address
*POC Phone Number
*Country
*Address 1
Address 2
*City
*State
*Zip/Postal Code
*Membership Type
Academia/Nonprofit - 3 Yr ($1350)
Academia/Nonprofit 1 Yr ($500)
Government/Military 1-Year ($350)
Consulting Corporate 1-Year ($525)
Consulting Corporate 3-Year ($1400)
Small Corporate 1-Year ($1125)
Small Corporate 3-Year ($3050)
Medium Corporate 1-Year ($2000)
Medium Corporate 3-Year ($5400)
Large Corporate 1-Year ($3625)
Large Corporate 3-Year ($9790)
Sustaining 1-Year ($6875)
Sustaining 3-Year ($18560)
*Name on Card
*Card Number
*Card Expiration
/ (MM/YY)
*CVV
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