Membership Application
First Name: *
Last Name: *
Email: *
Address: *
Address 2:
Department:
City: *
State: *
Zip/Postal Code: *
Zip+4 (USA Only):
Country: *
Phone: *
Extension:
Inland Northwest Peace Corps Association (INPCA) individual annual membership is $15.00 per year. National Peace Corps Association (NPCA) individual annual membership is $35 per year.  You may also optionally select Group Memberships at a cost of $15 per group, per year.
Service History (At least years are required for the dates)
Country
Start and End Date
Service Category
Information on additional tours of service.
Payment Please print this form and send with a check made out to INPCA
Total:
Denotes Required Field *