New Search
aaauraarwvcw,tuaroosrsw <br />AMA <br />Send Membership Payments to: <br />Replacement/Addition <br />PO Box 8022s8 <br />_ <br />Kansas City, MO 64180-2286 <br />Send Other Correspondence to: <br />F <br />2345 Grand Blvd, Suite 700 <br />orm <br />Kansas City, MO 641 0 8-26 25 <br />816-472-8100.F= 816-472-105 <br />8004 49.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 rnay 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 fin d 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 816-472-6 100 within Kansas City, Missouri rneno area) or e-mail mernkrship[a)apa wamet. <br />If your Actual Roster Count is less than the Base Croup <br />Count, you should add more names to your roster. No <br />additional fee will apply provided the Actual Roster <br />Count is not greater than the Base Group Count <br />If your Actual Roster Count is greater than the <br />Base Group Count, your group is invoiced an <br />additional member fee of $116. ($US) per person for <br />the difference. Chapter dues will also be affected. <br />AR, AZ., CA, CT, DC, IL, MA, MD, MN, NC, NH, <br />NJ, NY, OH, RI, TN, TX, UT, VA, VT, WA, and <br />WI residents should contact APWA for details. <br />Group ID Number: 35!y <br />O Mr. ❑ Mrs. Kris Olson Traffic System Maintenance Supervisor <br />O Dr. M Ms. First Name Middle Initial Last Name Pteferred Name (fm badges) Title <br />City of Eugene; Public Works Maintenance 1820 Roosevelt <br />Organization (Agency/Fum) Department/Division Orrice Address <br />Eugene, OR 97402 541-682-4961,541-682-4882,Kris.D.Olson@ci.eugene.or.us <br />City State Zip+4 Work Phone Fax Work E-mail- <br />Horne Address (optional) Hoare Phone (optional) Home E-mail (optional)' <br />Preferred Mailing Address: ❑ Home Office Birth Year: <br />' E-mail addresses are only utilized for distributing APWA-related news and information. <br />® ❑ Mr. ❑ Mrs. <br />❑ Dr. ❑ Ms. First Name Middle Initial' Wt Name Preferred Name (for badges) Title <br />Organization(Agency/Firm) Department/Division <br />7jp+4 Work Phone - Fax Work E-mail' <br />Home Address (optional) Home Phone (optimal) - Home E-mail (optional)- <br />Preferred Mailing Address: ❑ Home ❑ Office Birth Year: <br />- E-mail addresses are only utilized for distributing APWA-related news and information. <br />