Honorary Membership

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Honorary Membership

To apply for or renew your honorary membership in AVAPL, please complete the following information. Honorary members do not pay dues. For an explanation of the levels of membership, please click here.

(Fields marked with * below are required fields. AVAPL will never sell this information to a third party and will use this information only to contact you about matters related to the organization.)

Please provide the following contact information:

*First Name
*Last Name
*Degree
*Job Title
*Facility
*Location
*Street Address
Address (cont.)
*City
*State
*ZIP Code
*Work Phone
FAX
*E-mail

The level of membership for which you are applying or renewing:

Honorary Member

If you want to send your application form by mail, please print out this page and mail it. For the address to send your application, please e-mail Ann Landes, Treasurer at trea...@avapl.org (In order to thwart spammers, clicking on the above e-mail links requires you to respond to a "challenge" before the e-mail address is revealed. You need to click on the underlined ellipses [...] to activate the link.)

Click the "Submit" button below to submit your application electronically. Click "Reset" to clear the above information and start over.

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