Pennsylvania Taxidermist Association, Inc.

PTA Member's Web Listing Form  

If you are a member and want your membership listed on the PTA's Web site, you must complete the following form and submit it to the Membership Secretary. If you are listed here and have a change to make, complete this form and submit it to the Membership Secretary.
This form is not a membership application.

Select one:

Select County in Pennsylvania or Out-of-state:

Business Name:
(If none, leave blank.)

Member's Name:

Check as applicable: Licensed Taxidermist and/or Certified Taxidermist

Street Address:

City: , State: Zip Code:

Work Phone: Include Area Code, Ex: 814-123-4567

Home Phone: Include Area Code, Ex: 814-123-4567

Fax: Include Area Code. Ex: 814-123-4567

Web Site NAME:
(Your site's name. Ex: Artistic Taxidermy Shop)

Web Site URL:
(Your site's Web address. Ex: www.artistictaxidermy.net)

Email Address: (Ex: joetaxi@myisp.com)

Print this form, check for accuracy, and mail to:

Delores Carley
628A N. Fraley St.
Kane, PA 16735

Thursday, March 29, 2007