Membership Type *

Regular Members: Any full-time employee of a city, county, or special district; any full-time state, federal, or university/ college employee, any full-time legislative assistant or other public sector organization

Student Members: Any full-time student enrolled in a college or university with an interest in pursuing a career in public service, local government, and/or public administration

Application Date *

MM

DD

YYYY

Name *

First Name

Last Name

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

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