ITAA Recurring Billing Request - Addition
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Use this form if you wish to sign up for
ITAA's recurring billing. Please print it out, complete it legibly, and either
mail or fax to ITAA. |
I would like to automatically renew my ITAA
membership or Journal subscription (as noted), charging the annual fee to this
card.
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Signature:
__________________________________________________ |
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I would also like to automatically donate to the
following funds.
| DONATIONS |
| O |
Eric Berne Fund for the
Future |
$ _______ |
| O |
Scholarship Grant Fund |
$ _______ |
| O |
TAlent Program |
$ _______ |
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Signature:
__________________________________________________ |
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| MEMBERSHIP
CATEGORY |
| O |
Associate |
O |
Regular |
O |
Certified |
O |
Student |
| O |
Retired |
O |
Teaching |
O |
Journal Subscriber |
| CHANGE OF CREDIT
CARD INFORMATION |
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| O Visa |
O Mastercard |
O AMEX |
O Discover |
O JCB |
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Card number:
_______________________________________ |
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Expiration date:
(cannot expire
within next 365 days)
_______________________ |
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Email: (required for billing
notification)
___________________________________________________________ |
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| Mail or fax this form to:
The ITAA
2186 Rheem Drive
#B-1
Pleasanton, CA 94588
Fax: +1 925 600 8112
Thank You! |
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