Associate Member Application

Please complete the below form to request membership for our Associate Members Program.

Vendor Information

Please enter your company name:

Primary Company Address

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Primary Contact's Title

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Associate Membership

Yes! Sign me up to be an Associate Member! Yes! I want to be an Associate Member and understand the fee is $550.00 annually.

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Please supply a brief summary of your company / services::

Please select the category(ies) applicable to your company: Accounting Architects Asset Management Banking Communications Consulting Construction Contract Management Services Dining, Housekeeping, Laundry, Maintenance eGovernment Elections Employee Benefits Energy Engineering Finance Human Services Insurance Law Nursing Home Services Other Pension Services Prison Services Property Assessment Technology Transportation

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County Commissioners Association of Pennsylvania
PO Box 60769 | Harrisburg, PA 17106-0769
Direct: (717) 526-1010 | Fax: (717) 526-1020
www.pacounties.org | @PACountiesGR

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