PWC Online Membership Application Form:

Please complete the form below and then click the submit button at the bottom of the page.
Note: Credit cards accepted through PayPal for payment of dues.

Fields marked * are required.

Name*:
Prof. license or title:
Company:
Company title:

Please indicate preferred mailing address:


Business:

Address:

City:

State:
Zip:

Country:
Phone:

Cell Phone:

Fax:

Email*:
Website:



Type of Company & Specialty:
i.e., GC, CM, Sub. Prof. Service, Consulting, Supplier, Manufacturer. Please be specific regarding product(s).


Are you an owner
of the company?:

Percentage
owned by you?:
%

Your status with
the company:

Annual
Gross Sales:

 

Home:

 Address:

City:

State:
Zip:

Country:
Phone:

Cell Phone:

Fax:

Email*:


Chapter Preference*:
 You may vote and/or hold elected office only in the Chapter to which you belong. You may attend events of any Chapter at member discount rate.

 

Membership Categories*:
 Final approval of membership is at the discretion of the PWC Board of Directors.

 Corporate A: gross income: $5M+ / entitled to 6 representatives / annual dues: $750
Corporate B: gross income: under $5M / entitled to 4 representatives / annual dues: $450
Business: sole prop./consultant with 3 or fewer employees / entitled to 2 representatives / annual dues: $275
Individual: employee / entitled to self-representation (does not extend to employer) / annual dues: $225
Student: matriculating at accredited institution; non-voting category / annual dues: $65

Corporate or Business applicants, please provide the names, titles, telephone numbers, fax numbers, and email addresses of your representatives:

Student applicants, please indicate:

School:
Area of concentration:

 

Business Survey:
 Please complete anything applicable.

If you or your company are members of other business or professional associations, please list association names:

Is your business owned (5l% or more) and controlled by:

Is your company currently certified by any government agency as:
Minority Business Enterprise (MBE)
Disadvantaged Business Enterprise (DBE)
Women's Business Enterprise (WBE)

Please indicate agencies that have certified your company.

If the company is not certified, do you wish to receive information on the certification process?


Enter the code shown in the image: