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General Information:
 
*Date
*Company Name
*Prefix
*First Name:
*Last Name:
*Title:
*Address Line 1:
Address Line 2:
*City:
*State:
*Zip Code:
*County
*Phone:
Phone Extension:
*Fax:
*E-Mail:
 
Company Information:
 
 
*Your Company belongs to what industry?
Manufacturing Retail Service Other 
*Please briefly describe the nature of your business:
Remaining Characters		250 Character Limit
*How many MO full-time employees do you have?
*Is your Parent Company information the same as that listed in General Information?
Yes No 
 
Please enter any information about your Parent Company DIFFERENT than that listed in the General Information section above.
 
Company Name (Parent Company)
Address Line 1 (Parent Company) :
Address Line 2 (Parent Company):
City (Parent Company):
State (Parent Company):
Zip Code (Parent Company):
 
Membership Information:
 
MEMBER OFFICIAL:

Please designate a person within your company to be AIM`s Member Official. This person will have voting rights for issues
requiring a vote according to AIM`s bylaws. This person will also receive all regular correspondence from AIM.
 
*Is your Member Official the same person listed in the General Information Section?
Yes No 
 
Please enter any information about your Member Official DIFFERENT than that listed in the General Information section above.
 
First Name (Member Official):
Last Name (Member Official):
Title (Member Official):
E-Mail (Member Official):
Address Line 1 (Member Official):
Address Line 2 (Member Official):
City (Member Official):
State (Member Official):
Zip Code (Member Official):
Phone (Member Official):
Phone Extension (Member Official):
Fax (Member Official):
 
 
DUES OFFICIAL:

Please designate a person within your company to be AIM`s Dues Official. This person will recieve an annual memebership renewal invoice from AIM. This person will also receive all regular correspondence from AIM.
 
*Is your Dues Official the same as your Member Official?
Yes No 
 
Please enter any information about your Dues Official DIFFERENT than that listed in the Member Official section.
 
First Name (Dues Official):
Last Name (Dues Official):
Title (Dues Official):
E-Mail (Dues Official):
Address Line 1 (Dues Official):
Address Line 2 (Dues Official):
City (Dues Official):
State (Dues Official):
Zip Code (Dues Official):
Phone (Dues Official):
Phone Extension (Dues Official):
Fax (Dues Official):
Payment Information:
 
Associated Industries of Missouri uses a bracket system to calculate your minimum annual dues amount. Please select the bracket below containing your company`s current number of Missouri full-time employees.
 
 
*Please select your payment arrangements:
 
*How many MO Employees do you have?
0 - 25
26 - 75
76 - 150
151 - 500
501 - 1000
1001+
Minimum Membership Investment Due:
Minimum Membership Investment Due:
Minimum Membership Investment Due:
Minimum Membership Investment Due:
Minimum Membership Investment Due:
Minimum Membership Investment Due2:
 
*Amount Remitted:
*Credit Card Type:
*Credit Card Number:
*Credit Card Expiration Month:
*Credit Card Expiration Year:
90.64 percent of membership dues and contributions paid to Associated Industries of Missouri may be deductible as a business expense under Internal Revenue Service code, Section 162, for federal income tax purposes. The remaining 9.36 percent is expended for direct lobbying as specifically defined by federal law and is not deductible. Membership dues and contributions are not deductible as charitable contributions.

I certify that I am the authorized user of the credit card indicated in this web form. By clicking “Submit”, I authorize Associated Industries of Missouri to charge the credit card indicated, for the amount indicated in the “Amount Remitted” field, for a one year membership in Associated Industries of Missouri, starting from the date I submit this form.
 

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