New Membership NOTICE: This form is for joining SPSWA for the first time. If you have previously registered on this site then you need to use the RENEW Membership form. "*" indicates required fields Choose a Username* RECOMMENDED: Use your first name and then your last name as your username (e.g., janefitzgerald for "Jane Fitzgerald") as it is more likely to be unique. You will use this username, or your email address, to sign in to this website. Choose a Password Enter Password Confirm Password You will use this username, or your email address, to sign in to this website. Later on if you forget this password, you will be able to use the "Lost Password?" process to reset it and choose a new one. Name* First Last Organization* If your company name includes an "LLC" or "inc" etc, please DO NOT type the comma.Your Title* Organization Category*Please select...Adult Day Health CareCommunity Based CareFinancial/LegalHomecareHospiceHousingLong Term CareOtherYour Email* This is the email you will use when logging in, if you forget your password, and so on. Work Phone*Personal PhoneAddress* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Choose Membership LevelMembership Type* New - $30 Student - $15 Retired - Free Click on any circle to select your membership type and the credit card box will appear if needed (e.g., it will not appear if the free "Retired" selection is made).Credit Card*Card Details Cardholder Name EmailThis field is for validation purposes and should be left unchanged.