Register for Membership

This section is for member registration and should be filled out and signed by the voting member.

Payment for membership dues can be made by check or credit card under “membership payments” in the menu above.

Section 1: Voting Member Registration

This section must be completed and signed by the designated voting member for your state. Each state may designate only one voting member (alternates or proxies may not be appointed). In accordance with NASRA bylaws, each state is allowed only one vote on matters, and the vote must be cast by the person designated on this form.

Name of Designated Voting Member(Required)

First Last

Agency/Organization Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

As the designated voting member for my state(Required)

I consent to receive notices, communications, and information regarding NASRA business by electronic communications to the above e-mail address.

I DO NOT consent to receive notices, communications, and information regarding NASRA business by electronic communications to the above e-mail address.

Place a check in the appropriate box

Signature

How will payment in the amount of $300 be made?(Required)

Credit Card

Check

Unsure

Credit Card payments will be paid by the appropriate person using the "membership payment" form.

Confirmed

Check payments will be paid by the appropriate person using the "membership dues check payments" form.

Confirmed