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1 <br /> AMEA(CANPUBGCWORKSAi50CIATfOM <br /> ~ ¦ _ <br /> YourCompreheasive Public Works Rewurce <br /> Send Membership Payments to: Re„' a Ce ~ e 11 t~AC~ d t i o n <br /> PO Box 802296 <br /> Kansas City, MO 64180-2296 <br /> Send Other Correspondence to: ~ O <br /> 2345 Grand Btvd, Suite 700 <br /> Kansas City, MO 64108-2625 <br /> 816-472-6100 • Fax: 816-472-1905 <br /> 800-848-APWA <br /> If you would like to replace or add a member to your group roster, please use this form and return with renewal <br /> payment. Photocopies may be used if needed. Also identify any members which are to be removed from original- <br /> roster. <br /> On the back of this form you will-find an explanation of the types of membership available and the benefits included <br /> with membership. If your renewal notice reflects local chapter membership dues, these dues must be paid in order to <br /> maintain your local and national membership in APWA. <br /> if you have any questions regarding your group roster or you would like to verify the amount due for additions; call <br /> 1-800-848-APWA (or 816-472-6100 within Kansas City, Missouri metro area) ore-mail membershi~(a,a wa.net. <br /> If your Actual Roster Count is less than the Base Group If your Actual Roster Count is greater than the <br /> Count, you should add more names to your roster. No Base Group Count, your group is invoiced an <br /> additional <br /> fee wtll apply provtded the Actual Roster additional member fee of $110 ($US) per person for <br /> Count is not greater than the Base Group Count. the difference. Chapter dues will also be affected. <br /> AR, AZ, CA, CT, DC, MA, MD, MN, NC, NH, NJ', <br /> NY, OH, RI, TN, TX, UT, VA, VT, WA, and WI <br /> residents should contact APWA for details. <br /> ~ ~ <br /> Q ,C~°Mr. ? Mrs. Vl ~ 6 ~ ~ <br /> ?,Dc. ? s. ~ First Na/ne Middle Initial _ Last Nam Prefereed Nat {for badges). Title <br /> Organi lion ( gency/Fit Department ivision ~Oyr+fl~fi~-ce Address ~/l 1~i <br /> Ci ~ ~ c tit 1~- ~'~VG~y ~.Jt~ <br /> a ty 1. / State Zip+4 Work Phone Fax ork Ednail* <br /> Home Address (optional) Home Ph~o <br /> e (optional) <br /> Preferred Mailing Address: ? Home lld" Office <br /> * E-mail addresses are only utilized for distributing APWA-related news and information. <br /> }U~t . <br /> ? Mr. ? Mrs. ~ ~ ~ ~ " ~i~~~ <br /> ? Dr. CN~i~Is. First Name Middle Initial Last Name Prefeu-ed Name (for badges) Title l!t <br /> Organ hon (Agency/F n) Department/Division Office Address <br /> ~ Aga-~~~~~ ~ ~~f(~~-~~~~ ,lie c~`t~e~~~. <br /> Cit State Zip+4 Work Phone Fax Work E-mail* ~~~7,p t ~ V°^+ <br /> Home Address (optional) Home Phone (optional) Home E-mail (optional)* <br /> Preferred Mailing Address: ? Home Office <br /> * E-mail addresses are only utilized for distributing APWA-related news and information. ~ ~ ~V` <br /> <br /> _ <br /> <br />