EmailMe Form - ASPPA Affiliate Membership

Name *

Prefix First MI Last

Company: *

(provide company name, even if home address is noted below)

Company Owner’s Name(s)

Title: *

I am the owner

Address Type *

Home Address

Business Address

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Work Phone *

### - ### - ####

Home Phone

### - ### - ####

Home ZIP Code (for government affairs purposes):

Work Email Address: *

Personal Email Address

Which position best describes your job function? *

Which business most closely describes your place of employment? *

Code of Conduct:

Have you been found guilty of a felony, violation of insurance or securities regulations or any violation of the code of ethics of any professional or business
organization? *

Yes

No

If yes, please explain.

*

I have read the ASPPA Code of Professional Conduct and if my application is accepted I agree to abide thereby. I certify that the information provided in this application is true and correct to the best of my knowledge. The ASPPA Code of Conduct can be found online: https://www.asppa-net.org/footer/code-of-conduct/

Signature *

Clear

Date: *

MM / DD / YYYY

Dues Payment:

Dues are paid on a calendar year cycle. New membership dues are prorated based on join date. *

Jan 1 - Jun 30: $685 (dues through 12/31)

Retired or Government Employee: $100

Jul 1 - Oct 31: $345 (dues through 12/31)

Full-time Student (must provide copy of paid tuition bill): $100

Nov 1 - Dec 31: $685 (includes next year’s dues)

Add NAPA Membership: $100 annually

Add NTSA Membership: $100 annually

I am paying by: *

Check

Credit Card

Type of Credit Card Payment *

Mastercard

Visa

Amex

Discover

Name as it appears on card *

First Last

Credit Card Payments *

Signature *

Clear

Check Payments:
Paying by check? Please print a copy of your completed application and send with check payment to: ASPPA, P.O. Box 34725, Alexandria, VA, 22334-0725.

Questions? Please call us at 703-516-9300.

Tax Deductions:
Dues, contributions or gifts to ASPPA are not deductible as charitable contributions; they may be deductible, however, as ordinary and necessary business expenses. Federal law prohibits a tax deduction for the portion of membership dues attributable to lobbying expenses incurred by the organization. Consequently, for 2025, 18% of your dues are non-deductible in accordance with this provision.