AICUP CA Application

Corporate Affiliate Application

Name of Company(Required)

Name of AICUP Member School Client(Required)

Complete USPS Address(Required)

Website(Required)

Description of Company (100 words or less)(Required)

Primary Contact(Required)

This person will be listed in AICUP publications and on the website. This person should be the one an interested person would contact for more information.

Title(Required)

USPS Address(Required)

If different from address listed above.

Telephone Number(Required)

Email Address for Primary Contact(Required)

2nd Contact

Title

Telephone Number

Email Address for 2nd Contact

3rd Contact

Title

Telephone Number

Email Address for 3rd Contact

4th Contact

Title

Telephone Number

Email Address for 4th Contact

Comments

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