Gender

First Name

Last Name

DOB (Year-Month-Day)

Company (or Self Employed)

Position Title

Address

Address2

City

State

Zip Code

Work Phone

Home Phone

Mobile Phone

Fax

Email

Spouse

Password

Confirm password

Notes

Hide in Search

Years of Experience

Sponsor Member Name (1)

Required for new members only

Sponsor Member ID Number (1)

Required for new members only

Sponsor Member Name (2)

Required for new members only

Sponsor Member ID Number (2)

Required for new members only

AAPL Member (Y/N)

Yes

No

AAPL Member Number

AAPL Certification

None

RL

RPL

CPL

Membership Type

Active - $150.00

Associate - $150.00

Non-Resident - $75.00

Retired - $150.00

Honorary - $0.00

Payment Method

Credit Card Payment Online

Check Payment via Mail (will result in a "pending" membership status until payment received and processed)

Cash Payment via Mail (will result in a "pending" membership status until payment received and processed)

TAPL New Membership Application

Section 1. User Information

Section 2. Membership Information

Section 4. Payment Method