American Payroll Association Membership Enrollment Form

Enjoy all the benefits of APA membership: Professional status, Online Hotline Referral Service, Exclusive Members-Only access on the Web, electronic Payroll Currently, PAYTECH, paytechonlin.com, late-breaking news updates, and discounts on all the compliance resources APA offers! More about Benefits of Membership. To join the American Payroll Association complete the form below. For additional enrollments, make copies of this form. Please print clearly to avoid errors in your enrollment. Payment, in U.S. dollars, must accompany your enrollment form. Mail or fax the form to APA. You may also join ONLINE.

For your own security, do not e-mail this form.

FAX: 24 hours a day, 7 days a week. (210) 224-6038. MAIL: Send your check made payable to the American Payroll Association to: American Payroll Association 660 North Main Avenue, Suite 100 San Antonio TX 78205-1217 (210) 224-6406

AMERICAN PAYROLL ASSOCIATION Membership Enrollment Form

Enrollment Fee and Payment Information
	APA Membership
	Payment of $230 includes $195 Annual Membership Dues and one-time $35 Enrollment Fee*.	$230	$
TOTAL AMOUNT ENCLOSED			$

Please indicate method of payment:
	check (payable to American Payroll Association)
	Government/Public Sector Purchase Order #
	Personal Credit Card
	Corporate Credit Card
I authorize the American Payroll Association to charge my:
	American Express		Discover
	MasterCard		Visa
Card Number:		Expiration date:
Name on Card:		Signature:
Your payment MUST accompany your enrollment form.

Primary Address
Name:		Title:
Company:
Address:		City:
State/Prov:		Zip+4:
Country:
Telephone:	(___)	Fax:	(___)
E-mail:

Secondary/Home Address
Address:		City:
State/Prov:		Zip+4:
Country:
Telephone:	(___)	Fax:	(___)
SSN:		Birth Date(mm/dd/yy):
MMT:BEW
PLEASE SUBMIT a business-like photograph for APA member records with your Membership Enrollment Form (optional). Return this form with remittance. *An enrollment fee of $35 is charged to all new members. Enrollment fee will also be charged to reinstate members inactive for more than 90 days. Membership officially begins when payment is received. APA membership is an individual membership. APA does not provide corporate or institutional memberships. Membership dues are nonrefundable and are subject to change without notice.

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