Join Us Today

If you believe that your organization may benefit from becoming a member of NYAEMP please use the following form to submit your application. We look forward to welcoming you into our organization.

Please fill out the information contained below or Click Here to download PDF and fax it back to us.

AGENCY AND CONTACT INFORMATION (Please provide the requested information.)

Instructions: Please fill out the requested information. If your agency's information is pre-populated, please verify that the information displayed is correct.
* Required fields are indicated with a red asterisk.
* Agency:
* CEO:
* Address:
* City, State, Zip:      
* Fax: * Telephone:
Toll Free: TDD Phone:
Web Site:

For purposes of voting in membership meetings please designate a primary contact:
Primary Contact
* First Name: * Last Name:
* E-mail:
It is imperative for NYAEMP to have an email address in order for your agency to receive full benefits of NYAEMP membership.