Request Membership Information

Page 1 of 2

VPPPA Membership Information Request Form

By completing the form below, VPPPA membership information will be sent to the address provided within seven business days. If you have an immediate question, please call the VPPPA National Office at (703) 761-1146. ( * indicates required field)


Invalid Input
First Name (*)

Invalid Input
Middle Initial

Invalid Input
Last Name (*)

Invalid Input

Invalid Input
Job Title (*)

Invalid Input
E-mail Address (*)

Invalid Input
Phone (*)

Invalid Input

Invalid Input
Company/Org (*)

Invalid Input
Address 1 (*)

Invalid Input
Address 2

Invalid Input
City (*)

Invalid Input
State/Province (*)

Invalid Input
Zip/Postal Code (*)

Invalid Input

Please select a membership category below. For detailed category descriptions, visit the VPPPA Membership Category section. Vendors, please visit the Affiliate Member section.


Full Member Category: VPP approved worksite

Associate Member Category: Worksite pursuing VPP

International Member Category: Worksite outside U.S. pursuing the elements of VPP

Corporate Member Category: Headquarter office that oversees VPP approved worksite(s)

Non-profit Member Category: Non-profit 501 (c)(3) or (6) organizations

Union Member Category: Local or International union that support worksite(s) maintaining or attaining VPP

Agency: Federal, State, or territorial agencies that regulate safety and health working conditions not owned by the federal agency

Affiliate Member Category: Companies that provide products and/or services for the enhancement of the safety and health industry

Select Category (*)

Invalid Input

Invalid Input

Upcoming Events


03-04-2015 - 03-06-2015 2015 Region III VPPPA Conference


04-14-2015 - 04-16-2015 2015 Region IX VPPPA Conference


05-04-2015 - 05-07-2015 2015 Region VI VPPPA Conference

Contact Us

7600-E Leesburg Pike, Suite 100
Falls Church, VA 22043-2004

Map & Driving Directions

703.761.1146 Tel
703.761.1148 Fax