Registration by Credit Card

REGISTER HERE VIA PAYPAL WITH YOUR VISA, MASTER, AMEX, OR DISCOVER CARD

Name(Required)

First Last

Phone(Required)

Email(Required)

Business Name or Organization

Business or Organization Website

How Did You Hear About Us(Required)

ASIAINA Members

Family & Friends

Local Events

Social Media or Website

Event Partner

Community Partner or Collaborator(Required)

Small Business

Community/Group Affiliation

Non-Profit or Brand/Affiliate

N/A

Annual Membership Only

Price: $75.00

This is for 1-year new or renewal annual ASIAINA membership fee plus a free autographed book.

Donation or Sponsorship

Total

Billing Address

Street Address City State ZIP Code

Payment Method

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

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