* First Name

* Last Name

Organization

Title

* Address 1

E.g.: 1234 La Messa Drive

Address 2

E.g.: Apt 4

* City

* State AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming

* Zip

* Work Phone

* Home or Cell Phone

For weather emergencies/event cancellation purposes only.

* Email

Cost is $20 for PREP/APRA members and $50 for non-members.
(A brown bag lunch is included in the cost.)

Yes, I will attend the PREP/APRA-sponsored APRA Virtual Seminars event.

As a memeber -- $20

Organization or individual payment via PayPal

Organization or personal check mailed with copy of form

As a non-member -- $50

Organization or individual payment via PayPal

Organization or personal check mailed with copy of form