Associate Or Affiliate Member Application

FLORIDA COUNCIL PDCA Inc.

2009 Calendar Year

Return application to:
Florida Council PDCA
5245 Bowline Bend
New Port Richey, Fl. 34652

For additional info please contact:
Ken or Darlene @ 1-800-531-9132
E-mail: floridapdca@juno.com

Associate Member Application & Annual Dues

I wish to apply for membership in Florida Council PDCA and the chapter of PDCA. I have submitted a payment to Florida Council PDCA, along with this application.
Note: You must be a member of the Florida State council before becoming a associate member.

Chapter Joined:

Company name:

Contact:

Title:

Address:

City:

State:

Zip:

Office phone:

Home phone:

Cell phone:

Fax:

Web Site:

Upon acceptance, I agree to abide by current PDCA Code of Ethics, the Bylaws & Policies of the National Association, and any amendments
adopted during my membership. I will promote PDCA's standards in all business activities with fellow PDCA members and the public. I grant
PDCA the privilege of contacting me via phone, electronic means, and fax on matters related to my membership. I understand this
membership is for an Associate/Affiliate category.

Applicant's Signature & Date approved by Council Officer / Exec. Director

Sign here:

Recruited by:

Approved By:

ANNUAL MEMBERSHIP AMOUNT (2009)

(January - December membership)

Pay here with Credit Card

Please Print Form for your Records