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Member Application

Prefix

* First

Middle

* Last

Suffix (e.g. III, Jr, Sr, etc. )

Certifications to add after your name (Abbreviations only e.g. CPPB, CPPO, VCM, VCO, VCA, etc.)

* Working Title

* Agency/Entity Name

* Agency/Entity Address

* City

* State

* Zip

* Phone XXX-XXX-XXXX

FAX XXX-XXX-XXXX

* Email [email protected]

Alternate Email

Billing Company/Person

Billing Address

Billing City

Billing State

Billing Zip Code

Billing Phone

Years of Public Service

* Membership Classification

Board Approved
Local Public Body
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* Chapter Memberships (If no other Memberships, choose NON-NIGP Member)

CAPA Member
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* Select your Certifications

CPM
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None
VCA
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