Virginia Association of Governmental Purchasing

Membership Application

CHECK: If you wish to pay by check, or prefer to fax your information, please download the membership application.

CREDIT CARD: Please fill out the form below. Payment will be securely collected via credit card on the following pages.

Name:
Mr.   Mrs.   Ms.   Other:   Title:
Previously been a member of VAGP in years past?   Yes   No
Are you currently a member of NIGP?   Yes   No
Certifications received: CPPO    CPPB    C.P.M.    VCO
Other:
Agency / Organization:
Choose one: State Agency    City    County    Town
College / University    Community Service Board
Authority    Hospital    School
Other:
Office Address:
City / State / Zip:
Office Phone:
Office Fax:
Email:
Manager’s Name:
Manager’s Email:

Demographic Information

Male    Female    Do not wish to disclose
Education (choose highest level attained): High School/GED    Some College    Associates Degree    Bachelors Degree Masters Degree    PhD
Languages Spoken (choose all that apply): English    Spanish    French
Other:
Ethnicity: Native American    Asian    Black    Hispanic
White    Other:
Do not wish to disclose
Age: 18-29   30-39   40-49   50-55   56+
Do not wish to disclose
TOTAL = $

 


 
Large Chapter of teh Year Award 2011


National Institute of Governmental Purchasing
a chartered chapter since 1978

638 Independence Parkway, Suite 100, Chesapeake, VA 23320 | P 757-609-3696 | F 757-473-9897 | E info@vagp.org
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