American Atheists Affiliation Application
Before submitting an application, please make sure your organization has read and agrees with the affiliation information provided online at http://atheists.org/affiliation
Date:
Organization Name:
Official Abbreviation:				Number of Members:
Area of Coverage:
Meeting Information:		When do you meet? How often? Where?
Web Page:
Public Email:
Public Phone:				Public Fax:
Public Address:
City:
State:				Zip:
		If you do not have a public address, please give a private one for AA use only.
Private Address:
City:
State:				Zip:
The below information is for the use of American Atheists only and will not be made public.
Please provide personal (non-public) contact information.
Main Point of Contact:				Email:
	Title:			Phone:
Secondary POC:				Email:
	Title:			Phone:
Tertiary POC:				Email:
	Title:			Phone:
RETURN AFFILIATE APPLICATION TO:
Via Postal Mail:		Blair Scott, American Atheists
		PO Box 41, Ryland, AL 35767-2000
Via Email:		bscott@atheists.org
Questions?		Contact Blair Scott at bscott@atheists.org or at 256-701-6265.
FOR OFFICIAL AMERICAN ATHEISTS USE ONLY
Approved:						Date:
		National Affiliate Outreach Director
Approved:						Date:
		President, American Atheists
EFFECTIVE DATE:
Upon approval, forward to National Affiliate Outreach Director for immediate action.