Wyoming Professional Court Reporters Association 
Application for Membership

Name:        _________________________________________

Address:     _________________________________________

City:            _________________________________________            State:______________

Zip Code    ____________________________

Telephone:    ___________________________

Email:          ____________________________

Reporting/Certification/Experience:

Type of Reporter:    Freelance_________        Official___________        Other______________________________ (specify)

Certification:            CSR____________        State(s)_________________________________

                                RPR_____        CP_____        RMR_____        RDR_____        CLVS_____        CRR_____

Experience:            Years Reporting__________        Current Position______________________________________

Experience History (Voluntary) ____________________________________________________________________

____________________________________________________________________________________________

Special Interests/Concerns _______________________________________________________________________

____________________________________________________________________________________________

Do you wish to take an active role in the Association?    Yes________        No________

_________________________________________________________            ______________________________

Signature                                                                                                                Date

Questions?  (307)733-1461 or loviatt@courts.state.wy.us

Please make your check payable for $75.00  to WPCRA and remit payment along with this registration form to:

Merissa Racine 
P.O. Box 21432
Cheyenne, Wyoming 82003