Membership Form

NAPSA welcomes all current and former Adult Protective Service (APS) agencies, institutions, workers, and all supporters–any person or agency with an interest in APS and/or elders and adults with disabilities who are victims of abuse, exploitation and/or neglect. This form my be used for new memberships or renewals.  After completing this form, you will be taken to a page of payment options. For membership questions or concerns, please contact carol.carlton@napsa-now.org.

NOTE: NAPSA shares member contact information with other NAPSA members, but does not sell or otherwise release member information, except by member consent. To allow NAPSA to add you to internal NAPSA databases, please check yes below.

STEP 1 of 2: FILL OUT FORM

My contact information may be shared with other NAPSA members:  yes no

Is this a  NEW application or this is a RENEWAL application (check one)

Name & Title

Organization

Address

City

State

Zip

 

Phone

Fax

 

Email Address

 

If you are signing up for an organizational membership, please send an Excel file with each member’s information to NAPSA Memberships.