Student Subsidy Application

If you aren’t yet a member of AMEN, please click on the button below before filling out this form. You may also renew your AMEN membership using this link.

Membership

First Name *

Middle Name

Last Name *

Email *

Phone *

Address

City

ZIP

State State

Country Country

Area Of Study

Graduation Year

School

Arrival Date

Departure Date

Roommate Type Roommate Type

Spouse Name

Gender

I confirm that my spouse and I are already married

Yes

Deposit

Your deposit will be refunded if you attend the conference.

Deposit option *

I will mail in a check for the $100 deposit

Credit Card Deposit

Address

AMEN
PO Box 398
Weed, CA 96094-0398

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Student Subsidy Application

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