PLEASE PRINT OUT THIS APPLICATION, FILL OUT AND MAIL WITH YOUR CHECK TO THE ABOVE ADDRESS.



(Please Print or Type)
We wish to apply for membership in the _________________________________ Chapter of the New York State
Council, PDCA.

Full Name of Firm ___________________________________________________________________________

Contact Name ______________________________________________ Title ___________________________

Mailing Address __________________________________  City __________________County: _____________

State _____ Zip ___________  Business Phone (______)______________ Fax (______)__________________

E-Mail: _____________________________________ Website: _______________________________________

Date Firm was Organized ___________________ Business License/Federal Tax ID# ______________________

Upon acceptance, I will abide by the by-laws of the Chapter, Council & National Assoc., and any amendments
adopted during my membership.

Applicant Signature ____________________________________________________ Date __________________

Approved by __________________________________(Chapter/Council Officer)___  Date __________________

Recruited by ______________________________ Chapter ____________________Date __________________

Average # of employees ______                     Check One:     [ ] Open Shop     [ ] Union Shop

Services Provided (check one):        Primary:                                Secondary (if needed):
                                                      [  ] Commercial                        [  ] Commercial
                                                      [  ] Decorative                         [  ] Decorative
                                                      [  ] Industrial                            [  ] Industrial
                                                      [  ] Residential                         [  ] Residential
                                                      [  ] Wallcovering                      [  ] Wallcovering

   PDCA DUES INFORMATION

                               









                                      Annual Amount
**Total National/State Dues $__________
Chapter Dues                      $__________    * To these totals add individual Chapter Dues
Applicant Total                    $__________                 
                                         ** $15 of your national dues pays for your subscription to PWC magazine
                                                                     
MEMBERSHIP APPLICATION
Check One:
 Tier
 Gross Volume
 National Dues
 State Dues
 Total Dues*
(     )
 I
 Up to $300,000
 $330
 $225
 $555
(     )
 II
 $300,000 to
$500,000
 $330
 $270
 $600
(   )
 III
 $500,000 to
$3,000,000
 $495
 $270
 $765
(   )
 IV
 Over $300,000
 $645
 $270
 $915
NYS COUNCIL, PDCA
8560 Main St., Williamsville, New York 14221
(716) 632-6989   -   1-800-NYS-PDCA   -   Fax: (716) 632-8437
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