IAGA Individual Membership

Instructions: Step 1: Fill out this form completely and click the "Proceed" button at the bottom.  Step 2: Complete payment via Bank of America's secure server All information will be transmitted over Bank of America's Secure Webserver. Security is guaranteed by Bank of America. This will complete your registration.
General Information
First Name
Last Name
Title
Firm/Agency
Address
City
State / Province
Zip
Country	Two letter country code. e.g.: UK, AR, US
Business Phone
Home Phone
Fax
Email
Spouse/ Partner's Name
(Please Check The Appropriate Category)
Select Membership Level:	Select Level Gaming Attorney $300US Financial Specialist $300US Government Attorney / Regulator $50US Associate (Non-Attorney) $360US

NOTE: This application is on a secure transaction server. However, if you are uncomfortable sending confidential information over the Internet, please print this form and mail it with your payment to: International Association of Gaming Advisors 1930 Village Center Circle, #3, Box 501 Las Vegas, Nevada 89134 or FAX this application with your credit card information to (702) 543.6159