NYS Alliance for the Prevention of Sexual Abuse  Membership Form
Please fill out the form below to finalize NYS Alliance for the Prevention of Sexual Abuse Membership!

The next step is to pay your annual dues:

Professionals/Community Members Invested in Sexual Abuse Prevention: $35.00 per year

Students Invested in Sexual Abuse Prevention: $20.00 per year

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Email *
Name *
Today's Date *
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Is this a membership renewal or a new member application?
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Your Company/Organization
Professional Credentials (If applicable)
Business or Mailing Address *
NY Region or Other Area *
Phone number *
Identified Discipline *
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What do you hope to get out of your NYS Alliance Membership? *
A copy of your responses will be emailed to the address you provided.
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