alliedapp



	MARYLAND STATE PEST CONTROL ASSOCIATION ALLIED MEMBERSHIP APPLICATION Firm Name:________________________________________________________________________ Address:__________________________City__________________ State_____ Zip________ Phone: (____)___________________________ Fax:(____)__________________________ E-mail______________________Website Address: http://___________________________ Representative:__________________________________ Title:______________________ ----------------------------------------------------------------------------------------------------------------------------------------------- Any person, firm, or corporation not engaged in pest control service, that manufactures or supplies products, equipment, and/or other materials or services to the industry shall be eligible for Allied Membership. ------------------------------------------------------------------------------------------------------------------ ANNUAL DUES: $50.00 Dues paid cover membership through Dec. 31, 2009 ----------------------------------------------------------------------------------------------- Please enclose check made payable to: "Maryland State Pest Control Association" Mail to: MPCA Allied Membership P. O. Box 117 Marydel, MD 21649-0117 Signature:__________________________________ Date:_______________ Rev. 1/09 for MPCA Website