Maryland State Pest Control Association
and
National Pest Management Association

Active Membership Application

Firm Name:___________________________________________________________________________________

Address:______________________________City:______________________State:_____ Zip:__________

Phone:_____________________________  Fax:______________________________  Email:_________________________________

Authorized Representative:_________________________________________________  Title:_________________________________

***Please list any additional Branch Offices on reverse***
MPCA/NPMA DUES SCHEDULE

In computing annual gross dollar sales volumn for structural pest control,  include service performed in all locations including all branch offices in Maryland. Amounts listed below are the combined membership dues for both the Maryland State Pest Control Association and the National Pest Management Association..
Annual Sales       /   Annual Dues                    Annual Sales           /        Annual Dues

$1-$200,000...................$260.00                        $1,000,001- $2,500,000...........$865.00    
$200,001- $500,000........$330.00                                $2,500,001- $5,000,000.........$1,360.00
$500,001- $1,000,000.....$620.00                          Over $5,000,000...Call for quote

Dues paid cover joint membership through June 30, 2010
*Note--MPCA membership begins on reciept of application,                                           NPMA membership begins approximately 2 weeks later.

MPCA dues are $150.00 per year, the balance are NPMA dues.

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Please enclose check in the correct amount made payable to :
Maryland State Pest Control Association
Mail to:  MPCA/NPMA Joint Membership
                   P.O. Box 117, Marydel, MD  21649
If elected to membership I agree to comply with the Code of Ethics, and other policies of the Maryland State and National Pest Management Associations.


Signature:_______________________________________________  Date:__________________________