Register Membership PlanMembership Plan new prod test product $2.00/monthnew myproduct $15.00(created by Stripe CLI)Contact InformationFirst Name* Last Name* Suffix Email Address Secondary Email Address Mobile Number* Address TypeWork AddressHome AddressStreet Address Street Address (Cont) City StateAlabama, ALAlaska, AKArizona, AZArkansas, ARCalifornia, CAColorado, COConnecticut, CTDelaware, DEFlorida, FLGeorgia, GAHawaii, HIIdaho, IDIllinois, ILIndiana, INIowa, IAKansas, KSKentucky, KYLouisiana, LAMaine, MEMaryland, MDMassachusetts, MAMichigan, MIMinnesota, MNMississippi, MSMissouri, MOMontana, MTNebraska, NENevada, NVNew Hampshire, NHNew Jersey, NJNew Mexico, NMNew York, NYNorth Carolina, NCNorth Dakota, NDOhio, OHOklahoma, OKOregon, ORPennsylvania, PARhode Island, RISouth Carolina, SCSouth Dakota, SDTennessee, TNTexas, TXUtah, UTVermont, VTVirginia, VAWashington, WAWest Virginia, WVWisconsin, WIWyoming, WYCountryUnited StatesCanadaMexicoProfessional InformationWork Place Title Website URL Work Email Phone Ext PA Membership? List of All Licenses HeldDo you own, have any interest in, are employed by, or benefit financially or otherwise from construction, restoration, loss related vendor, insurance company or agency? If yes, please explain.User Directory BioAdditional InformationHow would you like to become actively involved in LAPA?What benefits would you like to receive from your LAPA membership?I agree to abide by the LAPA By-Laws and Code of Conduct adopted and/or amended by LAPA. My signature affirms that all information listed on this application is true and accurate. Signed: Create a New Password For Your AccountPassword* Confirm Password* Only fill in if you are not human
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