PVF Round Table Membership Application

Membership in The PVF Roundtable is maintained by Company. Each Company has one vote and a single Primary Representative, to who all organizational correspondence is addressed. Additionally, each Company has the option of listing up to five additional employees to be Name Alternative Representatives. All verified Company employees are encouraged to attend meetings and to participate in Roundtable activities. The present Membership Fee is $450.00, which extends for the 12 month period from being enrolled. A formal invoice is attached for your Membership. Please complete this form and return it to our office for processing. Please use additional sheets as necessary. Thank you and welcome to The PVF Roundtable.

Primary Representative
Name	Email	Date	02/24/2009
Address	City	State
Company	Phone	Zip Code
Category

Alternate Representative 1
Name	Email
Address	City	State
	Phone	Zip Code

Alternate Representative 2
Name	Email
Address	City	State
	Phone	Zip Code

Alternate Representative 3
Name	Email
Address	City	State
	Phone	Zip Code

Alternate Representative 4
Name	Email
Address	City	State
	Phone	Zip Code

Billing Address
Name	Email	Company
Address	City	State
Fax	Phone	Zip Code