LOCAL AGENCY MEMBERSHIP APPLICATION
Annual dues for local agency memberships are based on the population of the county or city your agency serves, using recent census data. A new membership can begin at any point in the year and will continue for 12 full months, at which time a renewal notice will be sent to your agency. Annual dues are:
COMPLETE ALL INFORMATION
AGENCY NAME
Agency Director
Ms.
Mrs.
Mr.
Dr.
First/Last Name
Title
Primary Address
City
State
Zip
Tel.
Fax
E-mail
Secondary Address
City
State
Zip
Tel.
Fax
E-mail
Preferred mailing address
Primary
Secondary
As a member benefit you may receive APHSA publications at no additional cost. Please select which of the following you wish to receive: Policy & Practice bimonthly magazine (please check which edition you prefer):
E-book electronic magazine (available through link on APHSA’s web site)
Print Edition
This Week In Washington (via e-mail, also accessible through the APHSA web site)
Electronic News Clipping Service (daily via e-mail)
Please send to this e-mail address:
PAYMENT INFORMATION
Please send invoice to
By clicking the submit button below you agree to pay APHSA the amount for the membership you selected in full, which will be charged to your credit card
in the following billing cycle.
APHSA Local Agency Membership Application - V1/2013
1133 Nineteenth Street, NW, Suite 400, Washington, DC 20036 | T 202.682.0100 | F 202.204.0071 | www.aphsa.org | memberservice@aphsa.org
Submit
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