Date:___________________________

Company’s Legal Name:_________________________________________________

Doing business as:_____________________________________________________

First name:________________________Last name:__________________________

Billing Address:________________________________________________________

Shipping address:______________________________________________________

Office phone:_________________________ Office Fax:________________________

Email address:________________________________________________________

Please include a copy of two of the following credentials with your registration:
1) AIA
2) ASID
3) CID
4) IADA
5) IDS
6) IIDA
7) Business card
8) Resale license
9) Business license
10) Proof of education for architecture or design