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Individual Membership Application

If you work for one of our corporate members, please contact Claudio Tapia by email about joining the Academy. 

If you have any questions feel free to contact us.

Use the form below to apply for an Academy of Interactive Arts & Sciences Individual Membership. PLEASE NOTE: Your submitted application will not be active until it has been reviewed and approved. At that time you will receive an email with further instructions.

ACCOUNT INFORMATION
Account Name (Email): *
   Re-type Account Name (Email): *
Password: *
   Re-type Password: *
First Name: *
   Last Name: *
Email Alert: *
Have an automated email alert sent when your account information is changed.
 
COMPANY INFORMATION
Company Name:
  Company Organization:
Job Title:
   
 
Phone:
  Fax:
Mobile:
   
 
Street 1:
  Street 2:
City:
   
State:
  Province:
Zip:
  Country:
 
PERSONAL INFORMATION
DOB:
   
Email:
  Phone:
Mobile:
  Fax:
 
Street 1:
  Street 2:
City:
State:
  Province:
Zip:
  Country:
 
EXPERTISE INFORMATION
Primary Area of Expertise:
  Year Started In Industry:
List of Game Titles:

EX: Call of Duty, Grand Theft Auto IV, Zelda		   Year Started Current Position: