Application for Associate (Alumni) Membership

I hereby apply for membership in the Association and agree to abide by its Constitution and By-Laws.  I understand that my membership is effective upon acceptance by the Association.

 

Please provide the following information based on your last position held:

Name
Title
Office Code / Location
Home Street Address
Address (cont.)
City
State
Zip/Postal Code
Phone
FAX
E-mail
Date
.
.
SIGNATURE

The annual membership fee for Alumni Membership is $26.00.  Make checks payable to "Philadelphia Region Association".

Please print this form out, complete it and mail it along with your payment to:

Tim Crews, PRA Treasurer
307 Beckley Crossing
Shopping Center
Beckley, WV 25801-5801