NCPLA Membership Application

First Name
Middle
Last Name
Employer
Address
City State Zip
Phone
Cell Phone
Email
Web
Spouse's Name
State Bar Number

Membership Categories:

 

Committees:

Please volunteer for ONE or more Association Committees:
  Communications Education
  Events Finance
  Membership Standards & Contacts
  Website & Directory

DIRECTORY INFORMATION

Client Listing

List all clients you wish to include in the NCPLA Directory. Please DO NOT abbreviate client names.
 

Specialties

Please select up to, but not more than 3 specialties (one per dropdown)
Specialties 1
Specialties 2
Specialties 3

AGREEMENT

I hereby apply for active membership in the North Carolina Professional Lobbyists Association. I am currently registered with the North Carolina Secretary of State ( or formerly, for retired members), and agree to comply with the Guidelines for Professional Conduct adopted by the Association.
View Code of Conduct
 (Initials) I have read the above statement and agree to it's content.
The North Carolina Professional Lobbyists Association was chartered in 1998 as a 501 (c)(6) not-for-profit corporation (tax identification #56-2086325). Your dues may be deductible as a business expense.
   - denotes required fields