AACT Monthly Organization Membership Form

Please use this form to sign-up for monthly membership payments.

Please note:

Payments will automatically be deducted from the credit card on file once this form is submitted.
ASCAP, Insurance, and MTI benefit redemption requires a 12-month commitment.
To cancel your monthly membership, please contact the AACT Office directly at 817-732-3177 or [email protected]

Monthly Membership

Membership Type *

Monthly Installments: Annual Budget Under $10,000 - $ 11.00

Monthly Installments: Annual Budget $10,000-$24,999 - $ 15.00

Monthly Installments: Annual Budget $25,000 - $99,999 - $ 25.00

Monthly Installments: Annual Budget $100,000-$249,999 - $ 37.00

Monthly Installments: Annual Budget $250,000 - $499,999 - $ 50.00

Monthly Installments: Annual Budget $500,000 - $999,999 - $ 70.00

Monthly Installments: Annual Budget $1 million and over - $ 120.00

Additional Donation

Total Amount

On Behalf Of Organization

Organization Name *

Phone (Main) *

Email (Main) *

Street Address (Mailing Address) *

City *

State / Province *

Postal Code *

Country *

Annual Budget *

Budget Year *

Account

Please enter a Username to create an account. If you already have an account please login before completing this form.

Username *

Check Availability
Punctuation is not allowed in a Username with the exception of periods, hyphens and underscores.

Password

Confirm Password

Provide a password for the new account in both fields.

Contact for Organization *

First Name *

Middle Name

Last Name *

Mailing Address *

Address Line 2

City *

Country *

State *

Postal Code *

Phone *

Email *

How did you hear about AACT?

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

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AACT Monthly Organization Membership Form

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