Form – Michigan AER

Select One*

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Organization

Primary Occupation

Referred by AER Member

Select Membership Type*

Name of the AER member residing in the same household*

Graduation Date*

University or College*

Expected Graduation Date*

Degree Program*

Advisor Name and Email*

Up to 3 Free Divisions Are Included with Your AER Membership

Total

$0.00

Name

This field is for validation purposes and should be left unchanged.