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Registry Profiles		 AIRA - American Immunization Registry Association Please select a membership category. (Required)
* denotes an organizational membership category
 * Organization ($200.00)
 * Affiliate ($200.00)
 * Business ($350.00)
 * Sponsor ($1000.00)
 Individual ($85.00)
 Reciprocal Partner ($0.00)
 Retired Life Charter ($0.00)

*Is this membership a renewal or new?
 New
 Renewal

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We do not currently accept credit card payments.
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 Electronic Funds Transfer (EFT)

Purchase Order Number: (Required if payment type is Purchase Order)