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?

Your AICP number

Personal email

Are you ...

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

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

Format: (000) 000-0000.

Work email

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

I want to pay by

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 Section Only Renewal

$36.00

Broward Section Only New Membership

$36.00

APA Florida Dual Section Member

Free

Total

APA Florida Broward Section Only Membership Application or Renewal