Membership Form

May VAAP include your name and address on lists that are made available to organizations or companies that may be of interest to you as an Activity Professional? YesNo

First Name (required)

Last Name (required)

Previous Name Used

Position/Title

VAAP Member #

Work Address

Facility Name

Street

City

State

Zip Code

Work Phone

Work Email

Home Address

 

 

Street

City

State

Zip Code

Home Phone

Home Email

New MemberRenewal

District (required)

Tax ID # 54-1381140

Do you want your email sent to your home or facility?

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