Membership Application

2022 Membership Application

Primary Member First Name

Primary Member Last Name

Primary Member Email

Primary Member Address

City

Primary Member Phone

Emergency Contact

Postal Code

Emergency Contact Phone #

Please check ONE:

Single (one adult - 18 yrs +)

Family (household with 2 adults and any number of juniors)

Junior (anyone who has not reached their 18th birthday as of Jan.1)

Single Family (household with one adult and any number of juniors)

Family Member #2 (eg.spouse)

Family Member #2 Email

Junior Member #1

Junior Member #2

Junior Member #3

I authorize my phone number and/or email to be shared with other members on request.

I want to subscribe to the newsletter.

I have read and agree with the APA Code of Conduct.View APA Code of Conduct