APPLICATION FOR MEMBERSHIP – Please Complete the following & mail to PO Box 5161 York, PA

COMPANY - _______________________________________________________________________________                          

COMPANY PRINCIPAL/REPRESENTATIVE -                                                                                                                        

PHYSICAL ADDRESS                                                                                                                                                                  

MAILING ADDRESS -                                                                                                                                                                

CITY  -                                                                                          ZIP CODE  - _____________+4___________                 

PHONE NUMBER - _                                                                   FAX NUMBER - _________________________        

CELL NUMBER                                                                             URL/website _______________________________      

*E-MAIL ADDRESS -                                                                   *Please include a current e-mail address!!

  LOCAL  MEMBERSHIP  $100.00