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Associate Member Application
Associate Member Application
Company Name
Company Website
Contact Name
Contact Email
(Required)
Phone
Fax
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Type of Firm
Wholesale Distributor
Manufacturer
Manufacturer's Rep or Agent
Type of Product/Work
(i.e., plumbing service truck bodies, shelving & bin storage)
Additional names and Email Addresses:
(If you wish additional employees in your firm to receive electronic information please provide their names and email addresses)
Annual Dues: $300 (Jan. 1 through Dec. 31)
(Required)
I understand that by providing the information on this membership application it indicates that I consent to receive faxes, e-mails, telephone, and regular mail service sent by or on behalf of PHCC--National Association, Indiana PHCC, and the applicable local chapter. We will send information that we, as your professional trade association, believe is important to you and your business. PHCC membership dues are not deductible as a charitable contribution for US Federal Income tax purposes, but may be deductible as a business expense.
Pay Online
I have paid online
If you would like to pay your associate member due of $300 online, please copy and paste this link http://www.inphcc.com/pay into a web browser. When paying online, you will be prompted for an invoice number: Please use your company's name as the invoice number.
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2024 Indiana PHCC Platinum Sponsors
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