Membership Profile: Add/Update Form

Please Note: Any updates or additions to NYAPPA membership records will be applied only to the NYAPPA membership database. Changes will not be reflected in the ERAPPA or APPA membership systems. The information collected is used solely for NYAPPA-related communications, including chapter meeting announcements and general updates about regional or national conferences. Please be aware that submitting this form will replace any existing data on file, as NYAPPA does not retain historical membership information.

Update/Change Profile

Institution*
Inst. representative first name*
Inst. representative last name*
Title*
Address*
City*
State*
Zip/Postal code*
Phone*
Fax
E-Mail*
Comments
Associate member first name
Associate member last name
Title
Phone
E-Mail
Associate member first name
Associate member last name
Title
Phone
E-Mail
Associate member first name
Associate member last name
Title
Phone
E-Mail