ARIZONA CROP IMPROVEMENT ASSOCIATION
Affiliated with:
School of Plant Sciences
College of Agriculture
University of Arizona
Web: arizonacrop.org		 2120 E. Allen Rd.
Tucson, AZ 85719-1522
Phone 520/305-3586
FAX 520/318-3587
E-mail: acia@arizonacrop.org

2014 Membership Application
      (Choose one category and enclose payment)*
______ ($50) ACTIVE (VOTING) MEMBER - Any person or business involved in
              production,conditioning, distributing or consumption of certified seed.
_____ ($25) ASSOCIATE (NON-VOTING) MEMBER - Any other person or business
            interested in supporting the purpose of the Association (pure seed production, etc.)
*ACIA reserves the right to assign membership category based on the stated criteria. Active
  member status is required to secure certification services.
Name of Member of Record______________________________________________________
                                                  (Print/type member's name - either individual or company)

Individual Representing Member of Record__________________________________________
                                                                                 (If different from member of record)
Address_____________________________________________________________________

City & State___________________________________________ Zip____________________

County (AZ Actives only)__________________________ Phone________________________

Fax_________________________E-mail___________________________________________

Please list name of other individuals at this or other addresses to receive newletters and other
courtesy mailings (provide addresses if different from above)
_____________________________________________________________________________

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Office Use: Date Received___________________ Check Number____________

MEMBER OF THE ASSOCIATION OF OFFICIAL SEED CERTIFYING AGENCIES