Please complete the following information for the primary contact for your organization. Your membership
fee of $95.00 includes one copy of any correspondence including the monthly minutes to be sent to this individual:
COMPANY
NAME: ____________________________________________________
____________________________________________________
PRIMARY CONTACT: ______________________________________________________
ADDRESS: ________________________________________________________________
CITY:
______________ STATE: ______ ZIP CODE: ___________
TELEPHONE: ______________________________________________________________
FAX
NUMBER: _____________________________________________________________
EMAIL ADDRESS: __________________________________________________________
NUMBER
OF EMPLOYEES/MEMBERS: ______________________________________
HOW IS PEAA INFO DISTRIBUTED TO EMPLOYEES: ____________________________________________________________________________
Please
return this form with your check payable to PEAA.
Send to: Chris Sterf
PEAA
PO Box 17123
Pittsburgh,
PA 15235-0123
