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| Company Name |
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| Title |
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| Address |
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| City |
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State |
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Zip Code |
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| Business Phone |
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Email |
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| Membership
Categories |
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| To
make the process easy, you can now pay for your PNW, State and National
Membership |
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| all
at one time. Please select each box that you would like to pay for on this
form. |
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| PNWAAA |
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| Operator |
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$150 |
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| Pilot |
$75 |
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| Allied |
$150 |
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| Associate |
$50 |
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Oregon |
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| Operator |
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$450 |
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Operator |
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$100 |
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| Pilot |
$170 |
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Pilot |
$50 |
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| Washington |
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Idaho |
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| Operator |
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$100 |
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Operator |
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$100 |
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| Pilot |
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$50 |
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Pilot |
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$50 |
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| Allied |
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$75 |
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Allied |
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$100 |
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| Associate |
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$25 |
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Associate |
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$50 |
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| Payment
Method |
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Total Enclosed $ |
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| Check
Enclosed # |
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or Credit Card (VISA, MC, AMEX) |
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| Card
Number |
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Exp. Date |
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| Name
on Card |
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Signature |
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| Billing
Address |
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State |
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Zip Code |
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| Return
This application to: PNWAAA |
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891 Prater Road |
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Ellensburg, WA 98926 |
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| Or fax to (509) 968-9330. Please call with Questions at (509)
968-3386 or email to pnwaaa@elltel.net |
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