Renew Your Affiliate Membership Today! (Non-profits & University types ONLY)

May 1, 2010 - May 31, 2011

If you are a non-profit or university type organization and you have been an Affiliate IPSA member within the last 2 years, please register your renewal by filling out the following form.

Register Online

Please complete the form below. After completion, you will have the option to pay with PayPal.

Company Name

Primary Contact

Address

City

State Select one Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming

Province Select one Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan

Zip

Phone

Toll Free Number

Fax

Web Site

Email Addresses for Key Contacts

please list the email addresses for each key contact in your organization

Type of Operation

Sole Proprietorship
Partnership
Subsidiary of Outside Corporation
Family/Independently Owned
Closely-held Corporation
Other

Affiliate Dues Classification Select one $250.00

Method of Payment

Pay online
Please send an invoice

please indicate your method of payment

Only fill out this form if you have been an Affiliate member of IPSA within the last 2 years

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