Member's Name
Member's Title
Organization Name
Address
City    State    ZIP
Phone    Fax
Email

Is this a new or renewal membership?
New
Renewal

Is this your own personal, individual membership or an organization's membership that you use?
Personal Membership
Organization's Membership

Are you currently a member of the national APRA organization?
Yes
No

Comments

Dues for the Virginia Chapter are $20 per person per year. Please send your check, payable to APRA-Virginia, to:

Delia Kloh, Treasurer, APRA-Virginia
University of Virginia
400 Ray C. Hunt Drive
P.O. Box 400807
Charlottesville, VA 22904-4807
434-924-0547
dak3s@virginia.edu

If your organization requires the chapter's federal tax ID number to process payment, use #54-175-7554.