Application for Membership

Name:
Organization:
Mailing Address:
City, State, Zip Code:
Business Address:
City, State, Zip Code:
Day Time: (Area Code / Phone Number)
Evening: (Area Code / Phone Number)
Fax: (Area Code / Phone Number)
E-Mail Address:
Country of Origin / Ancestry:

Membership Application Application Fee $10.00 to be paid in conjunction with the original membership fee. This is a one-time charge only.

Select your membership type:
Active Member ($25.00)
Public sector employee who is an administrator or professional. Membership has voting priviledges and is elegible to hold office.
Associate Member ($20.00)
Public sector employee who is NOT an administrator or professional. Membership has voting priviledges BUT CANNOT hold office.
Affiliate Member ($20.00)
An individual who supports NAHPA's objetives and is NOT a public sector employee. Membership does NOT have voting nor office holding priviledges.

Method of Payment
Check or Money Order will be mailed
Bill me at the above address

---

Make Check or Money Order to:

NAHPA P.O. Box 142171 Coral Gables, FL 33114-2171

---

Comments: (be as descriptive as possible)

---

This web site was designed by:   JALera Consulting Services, Inc.   Last update: June 7, 2000
Copyright 1996-2000© All Rights Reserved - Please report any problems to the webmaster.
Top of Page Home Page
JALera Consulting Services, Inc.
P.O. Box 126326, Hialeah, FL 33012-1605

---