APA Member Benefits Survey

1. Name:

2. Email:

3. Mailing address:

4. Telephone 1:

5. Telephone 2:

6. Check all that you are interested in or currently using from the APA Member Benefits Program:

	Financial products and solutions
	Electronic payment processing (accept credit cards and checks)
	Computers, printing and imaging solutions
	Car rental and travel discounts
	Discounts on office supplies
	Magazine subscription discounts
	Payroll and benefits solutions
	Discounts on hotels, vacation rentals and holiday packages
	Professional liability insurance and financial security products

7. Check all that you would like to see added to the APA Member Benefits Program:

8. Let us know how APA and APA Member Benefits Partners can let you know about specials, discounts and up-to-date program informaiton:

	E-mail	Mail	Phone
Financial products and solutions
Electronic payment processing (accept credit cards and checks)
Computers, printing and imaging solutions
Car rental and travel discounts
Discounts on office supplies
Magazine subscription discounts
Payroll and benefits solutions
Discounts on hotels, vacation rentals and holiday packages
Professional liability insurance and financial security products
Thank you, but I do not want to receive information about my member benefits

	Health insurance
	Prescription discounts
	Indentity theft prevention
	Legal services
	Exam preparation courses
	Online travel solutions
	Printing and business solutions
	Computer security and backup
	Mobile phones and services
	Home appliances and products
	Retail and restaurant discounts
	Flowers and gifts
	Shipping services
	Other