Application


	You may mail or fax this form or present it at any PPGBA meeting. PPGBA meeting places/dates are listed in the Calendar section of the website. Please make sure to include your membership payment and the $10 application fee with your completed form and sales tax documentation or full-time student documentation if applicable.

Name
Spouse/Life Partner's Name
Business Name
Business Phone #
Fax #
Home Phone #
Business Address
City
State
Zip Code
E-mail Address
Website Address
Home Address
Home City & Zip Code
Send Mail to	___ business address ___ home address
If PPA member, what is your member #?

Please check your requested membership category: Please review the membership category options before making your selection.

	Active (Applicants for professional active status must include a copy of their California Resale Number Documentation)
	Aspiring
	Additional Active
	Sustaining
	Additional Sustaining
	Colleague
	Out of State
	Student (must include a transcript showing full-time enrollment)

If you are applying for professional active status, please mark your specialty/ies:

	Commercial Advertising
	Digital/Electronic Imaging
	Portrait
	Wedding
	Other

	Dues for your category (Please review Categories/Dues for the appropriate amount to be paid.)
+ $10	Application Fee
	Less door fee credit for (dates)
	Total due check #

Visa or Mastercard #
Expiration Date
Cardholder Signature

How did you hear about PPGBA? (please check all that apply)

Website
Internet Search Engine
Golden Gate Schol
Vendor/Manufacturer
Postcard or mailer
PPGBA member
PPA
Colleague
Other

I certify that the above information is true and correct. I have read and agree to abide by the PPGBA Code of Ethics.

Applicant Signature
Date

For questions regarding this application please call: (650) 367-1265 or e-mail to fredenglish@ppgba.org

To mail the application and payment:
PPGBA
P.O. Box F
San Mateo, CA 94402-0018

To fax the application with a credit card payment:
(650) 369-4848