Pennsylvania Taxidermist Association, Inc.

2008 Membership Application and
Convention Registration Form
Please complete form, print, then mail with payment.
Date / /
  NEW PTA Membership RENEWAL             
Membership Number (if renewing)
Licensed Taxidermist Yes No   PTA Certified Taxidermist Yes No

Business Name

Last Name
First Name
Spouse Name
Address

County

City

State

Zip
Home - -
Work  - -
 E-Mail Address
Website Address
     
Would you like to donate to
the PTA Legal Fund?

$5 $10 $25 $50
Other        No, thanks.

$
Camp Compass Donation /
PTA's Youth Organization:

$5 $10 $25 $50
Other        No, thanks.

$

Membership Plan
(check one)


Single Membership $45.00  
Family Membership $60.00 
Lifetime Membership $750.00
Life memberships may be paid in installments—but must be paid in full within 2 years.

$
Convention Registration

Convention Registration:
Which Day for One-Day Registration:

Security demands everyone attending the Convention must wear name badges.
Please list names of all attending the convention:

Banquet - Buffet - Registration (Adults): ($35.00 ea.)

Banquet - Buffet - Registration (Children): ($15.00 ea.)

(Saturday Night — How Many?)     Total Banquet Meals:   $



TOTAL DUES / REGISTRATION / DONATION ENCLOSED  $
     

Make checks payable to:
PENNSYLVANIA TAXIDERMIST ASSOCIATION, INC. -- DO NOT SEND CASH

Send completed form and check or money order to:
DELORES D. CARLEY
PTA MEMBERSHIP SECRETARY
628-A NORTH FRALEY STREET
KANE, PA 16735

**** REMEMBER TO SEND THIS FORM BY 3-1-08****
IN ORDER TO BE ENTERED IN THE MUZZLELOADER PRE-REGISTRATION DRAWING.

You must be a paid member in good standing to compete.
Updated: Thursday, December 27, 2007