Non-Member Profile

Please select the non-member type that fits you best.

If you ARE a member of the APTA Virginia, please log-in to the website. Please do NOT proceed with this application. Things to consider:

If this is your first time to login to the website, you need to do a password reset.
If after you do a password reset and nothing happens, please contact vpta@vpta.org for assistance.

* Required Information

Member Type:

Membership Cost:	Non-Member PT $0.00
First Name:*
Last Name:*
Organization:
Title:
Street Address:*
Street Address (cont):
City:*
State/Province:*
OR Other:
Zip/Postal Code:*
Country:
Primary Email:*
Secondary Email:
Do you agree to receive e-mail correspondence from the association and its members?:*	Yes No
Do you agree to receive pertinent information related to issues covered by the association from interested third party entities?:*	Yes No
Phone:
Username:*
Password:*	Minimum of Six Characters
Confirm Password:*