AARC Benchmarking Subscription Order

Subscriber Status *

Current

Additional System Hospital

New, Member

New, Non-Member

Date of Order *

Hospital Name *

Address *

City *

State *

Zip Code *

Contact Name *

AARC Member Number

Contact Email Address *

Phone Number *

Benchmark Subscription Price *

Renewal ($100)

Additional System Hospital ($150)

New, AARC Member ($395)

New, Non-Member ($495) includes 1-yr membership

Discount Code

Special Discount

50%

30%

20%

Payment Information

Form of Payment: *

Credit Card

Check

Contact Name for Billing *

Email Address

Credit Card Authorization

By checking this box, I authorize the appropriate agent of the American Association for Respiratory Care (AARC) to bill the listed amount to the credit card below.

Name on Card

Credit Card Type

Credit Card Number

Expiration Date (mm/yy)

Authorized Signature

CVV2# (Visa/Mastercard - last 3 digits on back)

4 Digit Security Code (American Express - on front of card)

AARC Benchmarking Subscription Order

Payment Information

AARC Admin Only