New Organization Membership Application

Welcome to the New Organization Membership Application for the Commonwealth Prevention Alliance!

 

Select your membership level based on the number of sub-members you wish to enroll from your organization.

Memberships are good from January through December of the current year. Registrations occurring after June 15 will begin January 1 of the following year.

 

Complete the following information.  All fields marked with an asterisk (*) are required.  

The Primary Contact is the only person who will receive notifications about your organization membership including renewal and transaction emails.

 

If the Primary Contact is to be included as a member of your organization, be certain to include them in the sub-member list which follows on the next page of this application.

-

 

If you haven't done so already, create a Login Name and Password.  Passwords must be at least eight characters long, and contain at least one number.

 

This login information is unique to your organization account.  Therefore, avoid using any personal login name and password. 

 

CPA is divided geographically into four regions.  Check the counties where your organization provides services.   

 

From the list above, what is your CPA Region Number?

Powered by NeonCRM