Membership Enrollment Application

After entering the information requested below, click the Submit button at the bottom of the page.

First Name


Last Name

Home Address



Zip Code

Home Phone Number

Personal Email Address


Agency Code Number

Employee ID Number

Note: Employee ID number required for payroll deduction.        

Work Address



Zip Code

Business Phone Number

Job Title

Salary Grade

Paying Dues: Preferred Method (Check one)

  Payroll Deduction (Allow 4-6 weeks for processing)


  Direct Payment Credit/Debit Card  Paypal


You can now pay your dues online using our new PayPal feature. After completing and submitting your enrollment, go to the Membership page and link to PayPal via the "credit or debit card" link.

Membership recommended by:


My Assembly Member is:
Click here to find out who is your Assembly Person

My Senator is:
Click here to find out who is your Senator