AHA Membership Form Name
_______________________________________________________Address
_______________________________________________________City ______________________ State ______ Zip ______________
Telephone (_____)_______-______________
E-mail ____________________________________
Regular membership - $39.00/year
Family membership - $49.00/year
Senior/student membership - $25.00/year
Sustaining membership - $100.00/year
Corporation/Institutional - $2,500/year
Mail to: American Hydrogen Association
2350 W. Shangri La
Phoenix, Arizona 85028Print this form and mail with your check
Total Membership Amt.
_______________________________