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DEMONSTRATION SAMPLE

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Member Application

Prefix

* First

Middle

* Last

Suffix (e.g. III, Jr, Sr, etc. )

Certifications to add after your name (Abbreviations only e.g. CPPB, CPPO, VCM, VCO, VCA, etc.)

* Working Title

* Agency/Entity Name

* Agency/Entity Address

* City

* State

* Zip

* Phone XXX-XXX-XXXX

FAX XXX-XXX-XXXX

* Email [email protected]

Alternate Email

Billing Company/Person

Billing Address

Billing City

Billing State

Billing Zip Code

Billing Phone

Years of Public Service

* Membership Classification

Board Approved
Local Public Body
Retiree
State Public Body
Student

* Chapter Memberships (If no other Memberships, choose NON-NIGP Member)

CAPA Member
NIGP Member
NON-NIGP Member
Other Chapter Member
VAGP Member

* Select your Certifications

CPM
CPPB
CPPO
None
VCA
VCCO
VCM
VCO

Degrees

Masters
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Associates
Other
None

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Education Committee
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Member Login

WELCOME TO THE CAPA MEMBERS LOGIN LINK. Use Member ID or Email for Username
Demonstration Sample for NIGP ID:

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