Contact Information First Name: Last Name: Email: Phone: Override Default Username? Yes No If not “Default,” Set Username: Address 1: Address 2: City: State: Post Code: Country: Membership Information Override Default MCA Number? Yes No If not “Default,” set MCA Number: PROCEED WITH CAUTION Membership Type: AssociateDigitalStandard (US)F – Int’l Standard Membership Duration: years Dues Paid: Membership Starts Today? Yes No If not Today, choose date: You can also use this to manually set a specific expiration date