Protocol and Diplomacy International – Protocol Officers Association

MEMBERSHIP APPLICATION/RENEWAL FORM

CURRENT CALENDAR YEAR – ______

  1. _____Government/Military/Academia/Museum/Trade Association (Public Sector)...... $150

_____Corporate/Protocol Professional (Private Sector) ...... $300

  1. _____New/Lapsed Member Application Processing Fee...... $50

_____Renewal**...... No Fee

**No processing feeif membership is in good standing and dues are paid by March 31st.

DATE: ______

NAME: ______

(PREFIX/HONORIFIC, FIRST, MIDDLE, LAST/SURNAME, SUFFIX)

JOB TITLE:______

ORGANIZATION:______

ADDRESS:______

CITY/STATE/ZIP/COUNTRY:______

HOME PHONE:( )______WORK PHONE: ( ) ______CELL: ( ) ______

FAX: ( ) ______EMAIL:______

I give PDI-POApermission to list my name, title, affiliation & email address in the Members Only

section of the PDI-POA website as a way to introduce myself to currentmembers...... Yes ____ No_____

I give PDI-POApermission to list my name, title & affiliation (with no contact information)

in the Public section of the PDI-POA websiteas a way of sharing with the public

the diversity of PDI-POA membership...... Yes ____ No_____

PAYMENT: Check# ______(payable to PDI-POA)TOTAL DUE:______

OR Visa___MasterCard___NAME ON CREDIT CARD:______

BILLING ADDRESS (if different from above):______

______

CREDIT CARD #:______

EXPIRATION DATE:______LAST 3 DIGITS ON BACK OF CARD:______

PDI-POA is recognized as a tax exempt / non-profit trade association within the meaning of section 501 (c)(6)

of the United States Internal Revenue Service Code. Tax I.D. #20-0296867

How did you learn about PDI-POA?

Website____ Colleague (please provide name)______Other____

1

•NEW Applicants/Lapsed Members•

Send This page,RésuméPayment to

Ginger Barnard

Membership Chair, PDI-POA

8167 Zitola Terrace

Playa del Rey,CA 90293 USA

or by email to

or by fax to (310) 822-6850

•RENEWING Members•

Send This pagePayment by March 31st to

Roderic Ballance

Treasurer, PDI-POA

PO Box 55067

Riverside, CA92517USA

or by email to

or by fax to (951) 784-8688

1