GAPA Membership Application

Membership with the Guaranteed Asset Protection Alliance includes many valuable benefits, including legislative advocacy, regulatory updates, discounts on informative conferences and more. To join GAPA, please complete the following information and a GAPA representative will contact you to discuss your membership.

Company Information
Company Name*
Company Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Fax
Website*
Would you like to be included on the public GAPA member list?*
- Yes
- No
Company Logo (optional)
Accepted file types: png, gif, jpg, Max. file size: 1 MB.
For display on the website if approved by GAPA administration (PNG, JPG, GIF formats only).
Primary Contact
This information will also be used in creating the primary website access credentials.
Name*
First Last
Title/Position*
Email Address*
Enter Email Confirm Email
- I would like to enter a Secondary Contact
Secondary Contact
(optional) This information will also be used in creating secondary website access credentials.
Name
First Last
Title/Position
Email Address
Enter Email Confirm Email
Billing Information
Frequency*
- Annually
- Quarterly
Billing Contact*
- Billing address the same as firm address?
Billing Address
Street Address Address Line 2 City State ZIP Code
Submit Application
Comments or Questions
Email
This field is for validation purposes and should be left unchanged.

Company Information

Primary Contact

Secondary Contact

Billing Information

Submit Application