Member Request Link Form

AIA Long Island Chapter

499 Jericho Turnpike, Mineola, NY 11501

Tel: 516-294-0971 | Fax: 516-294-0973

Members Web Site Link Request Form :

All requests will be reviewed by the Chapter Office, before being submitted to the Web Site.
* Payment for Entry: $150.00 * Yearly maintenance charge: $100.00

	* = Required Fields
	Company Name :*
	Address :*
	Suite No. :
	City :*
	State :*
	Zip Code :*
	Phone No. :*
	Ext :
	Fax Number :
	Type of Work :*
	Web Site Address :*
	Principal Full Name :*
	E Mail Address @ Web Site :*
	Principal E Mail :*
	New Addition To Members Area Update To Existing Listing
	Payment method: Check Only - Fee: $150.00 Mail payment to: AIA LI Chapter Office, 499 Jericho Turnpike, Mineola, NY 11501 Note : Yearly maintenance charge: $100.00

	Questions or problems with this form, call chapter office for assistance.