APA Florida Broward Section OnlyMembership Application or Renewal

Please note the Broward Section-only Membership term is for a calendar year, January - December.

Contact the chapter office if you have any questions.

PERSONAL INFORMATION

Name*

First Last Designation (AICP, PE, CNU-A, Ph.D. etc)

Are you AICP?*

YesNo

Your AICP number*

Personal email

Are you ...*

renewing your Broward Section-only membership?submitting a new Broward Section-only membership?

For renewals, is there any change to your contact information (email, address, etc.)?*

YesNo

Provide new/updated address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code

EMPLOYMENT/STUDENT INFORMATION

Employer or school

Work address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Position or title

Work Phone

Work email

Where would you prefer to receive announcements/event information, etc.?*

PersonalWork

I want to pay by

credit/debit cardcheck

Make out check for $36 and mail to:

APA Florida

2017 Delta Blvd.

Suite 101

Tallahassee, FL 32303

On memo line: Broward section new/renewal membership.

Please note your membership is not active until we receive your check.

Broward Membership Options

Broward Section Only Renewal

$36.00

Broward Section Only New Membership

$36.00

APA Florida Dual Section Member

$ Free

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

APA Florida Broward Section Only Membership Application or Renewal