Individual Membership Application

Membership runs through the academic year and begins on July 1 and ends on June 30 annually, regardless of what point in the year you join. This chart below will be helpful in determining if you should join as an individual or institutional member.

If your employer is already a GPACAC Institutional Member, your Individual Membership is covered and managed through your Institutional Portal. You do not need to join via this form. If you are unsure if you are registered under your Institution, please consult with your Institution's GPACAC lead, or e-mail membership@gpacac.net. Check here to see if your employer has joined.

Membership Information

Membership Type

Do you have a fee waiver code?

Fee Waiver Code

Personal Information

First Name*

Preferred Name

Middle Name

Last Name*

Email*

Pronouns*

Hispanic?*

Phone - Work*

Phone - Mobile*

Birthdate*

Would you like GPACAC correspondence sent to a different mailing address then your employer?*

Mailing Address*

Country

Street

City

Region

Postal Code

Years in Profession*
(number of years only)

Mailing Address*

Country

Street

City

Region

Postal Code

Institution Attending

Institution Attending*
(Please choose from the autosuggest options - don't see yours? Email membership@gpacac.net)

What type of graduate program are you enrolled in? *

Other Description*

Employment Information

Current Organization/Employer Name *
(Please choose from the autosuggest options - don't see yours? Email membership@gpacac.net)

You have not chosen an employer from the dropdown. Please do so before submitting the form!

Current Title*

When did you start your current position?*

Are you a regionally based rep?*

Which GPACAC state(s) do you serve? *

Kansas

Nebraska

Oklahoma