Part One: Member Information

All fields are required.

  First Name:
  Last Name:
  Organization:
Your Email:
Phone Number:
 ()
Address:
City:
State:
Zip Code:
Type of Membership:

Individual

Agency Level 1 (2-5 employees)

Agency Level 2 (6-10 employees)

Agency Level 3 (11-15 employees)

Agency Level 4 (16-20 employees)

Agency Level 5 (20+ employees)

Number of Youth
in your program:
Age ranges served:
Are you interested in
any of the following?

serving on a board committee

starting a local TAA chapter

elementary school programming

middle-school programming

high school programming

youth development

If you are submitting an agency membership application, with multiple members, 
please fill out this next section completely. Otherwise skip this section.

First Name Last Name Email Phone