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ATLANTA CHAPTER
APA DATABASE UPDATE

                                                                                                                                      

 

ATLANTA CHAPTER
APA DATABASE INFORMATION

Keep your information updated by completing this form

Name:*

Title:

Certifications:

Company Name:

Company Address:

Company City/ST/Zip:*

Phone:*

Alternate Phone:

Fax #:

DOB (mm/dd):*

Years in Payroll:

Payroll Vendor:

Email:*

National APA #:

Active Member: 

YES
 

NO
Not Active, but would like to remain on list for updates 

YES
 

NO

ATL CHAPTER DUES DESCRIPTION:
Make Payment Here

Annual Membership for National APA Members: 

$40.00 (National APA Mbr)

Annual Membership for Non-National APA Mbrs:

$50.00 (Non-National APA Mbr)

Corporate Membership - One MUST be a Natl Mbr - Complete a form for each mbr

$100.00 (three Members Only)

Additional Corp Mbrs

$20.00 (Additional Mbrs-3 MAX)

List each member covered:

Member 1:

Member 2:

Member 3:

Member 4:

Member 5:

Member 6:

* REQUIRED FIELD

Copyright . APA ATLANTA CHAPTER. All rights reserved.
PO Box 421546
Atlanta, GA  30342-1546

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