Application Form

Details

Category: Sample Data-Articles

PRCA Membership Application

Print out this form, complete and fax to 205 599-5598 or scan and email to hugh@prcaonline.com

Payment may be by check or you can use your credit card and access the PRCA PayPal account for processing your renewal. See below for further information.

Last Name _______________________________________   First Name____________________ ___

Title______________     Company _________________________________________

Address ______________________________________________________________

City ______________________________________________

State ____________ Zipcode _________________________

Work Phone __________________   Cell Phone ___________________ Home Phone _______________

Email ____________________________   Web address: _______________________________________

Year PR work began ____________________________

Indicate your local PRCA Chapter:______________________________________

Dues New Member $120  (Dues are pro-rated after March of each calendar year. We will advise correct pro-rated amount upon application acceptance.

___ Please send me an invoice.  I will mail a check (remittance address below).  Membership not effective until check is received.

___ I wish to pay by credit card. After review of your application and its acceptance an invoice will be sent to you by email which will link you to the PRCA Paypal account. You do not have to have a PayPal account, just a valid credit card to pay.

Mail checks to:

PRCA –New Member Processing
PO Box 531335
Birmingham, AL 35253

(Using Any other PRCA address will delay processing of membership)