PALPA Members Registration Form

Please fill out the required fields. A member of the PALPA Staff will validate your request with your Membership Association. We will respond to you in due course. Note: If your request requires immediate attention, please contact us at
The items marked with * are required profile fields and need to be filled out.

Length must be between 3 and 20 characters.

Must be between 4 and 100 characters.

Confirmation of registration

To prevent automated registrations the board requires you to enter a confirmation code. The code is displayed in the image you should see below. If you are visually impaired or cannot otherwise read this code please contact the Board Administrator.

Confirmation code
Enter the code exactly as it appears. All letters are case insensitive.