East Bay Chapter of the APA

Membership Form

First Name:		Last Name:
Company:
Address:
City:	State: CA Zip:
Phone:	Fax:
Email:
APA Member: Yes No
Additional Mailing List Names for Company Members:
First Name:		Last Name:
First Name:		Last Name:
First Name:		Last Name:

Membership Fee

	$45	per individual (National Members) - entitles individual to attend all local chapter meetings (discount for year-end dinner), receive one copy of the newsletter, participate in study groups, receive chapter publications.
	$60	per individual (Non National Members) - entitles individual to attend all local chapter meetings (discount for year-end dinner), receive one copy of the newsletter, participate in study groups, receive chapter publications.
	$150	entitles any employees of the company at the same location, to attend all local chapter meetings (discount for year-end dinner), receive up to 4 copies of the newsletter, participate in study groups, receive chapter publications.

Complete this form online, then use your browser's print function to print it.
Mail the entire form and check to:

                                     East Bay Chapter APA
                                     PO Box 2777
                                     San Ramon, CA 94583

Please make checks payable to: East Bay APA Chapter

Questions about this site: lwatson246@aol.com