PTA Certified Taxidermist
Administered by the Pennsylvania Taxidermist Association, Inc.
Application Form

* Required information
* Name   * Date
* Business Name * Phone
* Address      Fax
* City   * State   * Zip
E-mail/Website:   
* State Tax ID #

Please use the PTACT Application Form Points Worksheet to determine total points earned.
 
New
Renewal
Points needed:
30
20
Points earned:
Application fee for Pennsylvania Certified Taxidermist through June 30, 2010:
 
New
Renewal
Non PTA Member:
$125.00
$  80.00
PTA Member:
$  75.00
$  40.00
PTA Member #:
Total Amt. Enclosed:
$
$
Print, sign and mail.
I hereby certify that all information provided is accurate and can be proven upon request.

Signature________________________________________________

Date_______________

In order to become a PTA Certified Taxidermist, you must have a valid Commonwealth of Pennsylvania—Department of Revenue—Sales Tax ID number and have accumulated 30 points (based on the PTA Certified Taxidermist Points Program). In order to renew, you must have accumulated 20 points during the previous term, and the application must be received during the renewal period (you will receive a renewal notice with these dates). If you do not renew in time, you must apply as a new member.

The first PTACT term will be from July 1, 2005 to June 30, 2010. For the first term, points may be accumulated from January 1, 2000.

The program will run from 2005-2010 / 2010-2015 / 2015-2020, etc. Applications will be received at any time during a term, however, anybody who becomes certified in the middle of a term will still be required to renew for the next term.

Renewal notices will be sent out 90 days prior to the re-certification dates.

Additional information and frequently asked questions can be found on this PTA Web site (www.pataxidermy.com)

Please mail your completed application with the appropriate fee to:
Dee Carley
628-A North Fraley St.
Kane, PA 16735

Return to PTACT Worksheet
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© The Pennsylvania Taxidermist Association, Inc. 2005. All rights reserved.

Thursday, December 28, 2006