Membership Summit Request and RSVP Form

2025 JPIA Spring Membership Summit

Name *

First

Last

Title, please indicate JPIA Director, Alternate JPIA Director or other Title: *

Email *

Address *

Address Line 1

City

State

Zip Code

Phone *

Please use the phone number associated with the participant attending the Membership Summit (cell phone).

From the drop down list below, please indicate the number of JPIA member districts you represent or if you represent a non-member entity. *

Select the District you represent from the drop down list below

Select the second District you represent from the drop down list below

Select the third District you represent from the drop down list below

Name of non-JPIA member entity that your represent

Are you the voting member? *

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