AACT Monthly Individual 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.
To cancel your monthly membership, please contact the AACT Office directly at 817-732-3177 or karen@aact.org

Monthly Membership

Membership *

Monthly Installments: Senior - $ 6.00

Monthly Installments: Individual - $ 9.00

Additional Donation

Total Amount

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.

First Name *

Middle Name

Last Name *

Mailing Address *

Address Line 2

City *

Country *

State *

Postal Code *

Phone *

Email *

Credit Card Information

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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