Register for Membership

Register & Pay for Membership

You may register and pay online below.

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

The second section is for credit card payment and can be filled out by whomever is responsible for payment.

If you wish to make payment via check, please click MEMBERSHIP DUES- CHECK PAYMENT after the voting member has completed section one.

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 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

Do you need a PDF copy of this form?(Required)

Yes

Section 2: Membership Payment(Required)

This section should be completed for credit card payments after the voting member has completed section 1. Payment is due July 31. Failure to pay state membership dues will result in suspension or termination of membership.

Price:

Designated Voter Name(Required)

Billing Name(Required)

First Last

Billing Email(Required)

State(Required)

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Total

Do you need a PDF receipt?(Required)

Pay for Membership(Required)

Card Details

Cardholder Name