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Your Name:_________________________________________
Job Title:____________________________________________
Company:___________________________________________
Preferred Address:____________________________________
___________________________________________________
Business Phone:___________________
Business Fax:_____________________
Type of Membership Desired (X one): ______Corporate ______Individual
Payment Method (X one):
______AMEX ______VISA ______MasterCard ______Check
Account Number:_________________________
Expiration Date:________________________
Name as it Appears on the Card:____________________________
Our Federal Tax ID is 52-1906152.
Mail this form to:
PDA, P.O. Box 630810, Baltimore,
MD, 21263 USA
Or, fax to +301-986-0296.
Our telephone number is
+301-986-0293.