Application Form for Full Dues Waiver Share First Name Last Name Address City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOut of CountryOhioOklahomaOntarioOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Phone Number E-mail Date of Birth I am applying for a full waiver of Academy dues Yes A member qualifies for a full dues waiver if (Please choose one of the following) The member is totally disabled and anticipates remaining so for the forthcoming calendar year. (A member in this category who is under age 55 and who has become totally disabled after 2007 must certify annually that he or she meets the stated criteria, by re-applying each year for a full dues waiver. A member in this category who is age 55 or older, or who became totally disabled prior to 2008, must so certify only in the first year in which he or she is in this category and need not re-apply in subsequent years; however, if such a member ceases to be in this category prior to age 70, he or she must notify the Academy office and will no longer be eligible for such full waiver.) The member is age 70 or older. The member is serving on active duty in the U.S. military, Peace Corps, or similar volunteer service. (A member in this category must certify annually that he or she meets the stated criteria, by re-applying each year for a full dues waiver.) Waivers are based on a member's status as of Jan. 1, 2018. All requests for waivers must be submitted by May 1, 2018. If you are granted a waiver and you no longer meet the stated criteria, you are obliged to notify the Academy and pay the full dues amount ($635). Other special circumstances warranting a partial or full waiver of dues will be considered by the Academy’s Membership Committee. Questions? If you are not sure whether you qualify for a dues waiver, please contact Emmy Mendizabal at the Academy email@example.com, 202.223.8196). Math question 7 + 9 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.