Join AIM

AIM Coalition Membership Form

I plan to join the Alliance for Immunization in Michigan (AIM) Coalition!
Below is my contact information.

Name

Title

Organization

Address

City

State

ZIP

Phone

Email

I am pleased to be a member of AIM as a:

General Member

Voting privileges, attends meetings, receives communications.

Associate Member

Receives communications, no voting privileges, meeting attendance not required.

I am interested in the following
committee(s):

Education & Website Committee
Fundraising Committee
Awards Committee
Membership Committee

After signing up for the above committee(s), the Chair will contact you.