Member Registration

Individual

$50 annual fee per person

Agency/Group

$150 annual fee

Allows four employees to join for the price of three! All employees must meet the eligibility requirements and be employed with the same agency.

Two Ways to Register

BY MAIL WITH CHECK

DOWNLOAD PRINTABLE REGISTRATION FORM

OR ONLINE

If you are a member of MPELRA, please log in and some of your account information will be auto-filled into the form below.

If any of the auto-filled information is incorrect, please go to your Member Account page and correct it.

How many applicants? (16 or less) *

Applicant #1 *

Price: $50.00

Applicant 1 Name *

First

Last

Title *

Email *

Confirm Email

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Jurisdiction *

Employer *

Total

$0.00

Member Registration

Individual

Agency/Group

Two Ways to Register

BY MAIL WITH CHECK

OR ONLINE

PAGE UNDER ACTIVE DEVELOPMENT.

DO NOT TEST AT THIS TIME.

Applicant #2

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