NATIONAL ASSOCIATION OF HISPANIC PUBLIC ADMINISTRATORS

APPLICATION FOR MEMBERSHIP

Name: ______________________________________________________________

Title/Classification: ____________________________________________________

Organization/Department _______________________________________________

Mailing Address: ______________________________________________________

City: _____________________________ State:______________ Zip:____________

Business Address: _____________________________________________________

City: _____________________________ State:______________ Zip:____________

e-mail: ______________________________________________________________

Business Phone: ___________________________  Cell: ______________________

Fax: ____________________________________  Home:______________________

Country of Origin/Ancestry: _____________________________________________

MEMBERSHIP FEES

Application Fee $10.00 to be paid in conjunction with the original membership fee. This is a one-time charge only.

Active Member:  Public sector employee who is an administrator or professional.     $25.00 Member has voting privileges and is eligible to hold office.

Associate Member:  Public sector employee who is NOT an administrator or

$20.00 professional. Member has voting privileges BUT CANNOT hold

office.

Affiliate Member:  An Individual who supports NAHPA’s objectives and is NOT a

$20.00 public sector employee. Member does NOT have voting nor

office-holding privileges.

Total enclosed: $ ___________________     Date: _________________________

Referred by: ____________________________________________

Signature: ______________________________________________

Send completed application, along with a check or money order made payable to:

NAHPA P.O. Box 142171, Coral Gables, FL 33114-2171 Membership is valid through the end of Fiscal Year, January 31.

Please press the print button below to print the application form.