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Membership Application
Please Print! BRANCH CHOICE (Select one or more)
Name ______________________________________________ Aquatics Branch
Position ____________________________________________ Community Recreation & Parks Branch
Employer/Agency ____________________________________ Park Resources Branch
Mailing Address _____________________________________ PA Therapeutic Recreation Society
City ______________________ State ____ Zip_____________ PA State Park Society (open to all DCNR employees only)
Address: Home Office Student at __________________
Phone: Office__________________ Home________________ SPECIAL INTEREST AREAS (Select all that apply)
Fax_______________ Email___________________________ Educator Urban Recreation Programming Trails
County __________________________ Commercial and Resort Recreation Youth Sports
Certification CPRP CPRA CTRS Other_________
Membership recruited by: ______________________________
Membership Dues are renewable on January 1 each year. New memberships received PAYMENT INFORMATION
July 1 to September 30 pay 50% of the annual dues. New memberships received after My check is enclosed. Please make checks payable to PRPS.
September 30 are credited toward the next full membership year. From each Bill my agency: Signature_______________________ Date_____
membership dues (except Friend), $10.00 is used for the publication of
Bill my credit card: ___ Visa ___MasterCard
PENNSYLVANIA RECREATION & PARKS and $6.00 is used for the publication of
PRPS UPDATE. PRPS is registered with the Pennsylvania Commission on Charitable Cardholder’s name_____________________________________
Organizations. A copy of the official registration and financial information may be Card #_____________________________ Expiration Date_____
obtained from the Pennsylvania Department of State by calling toll free, within Cardholder’s Signature__________________________________
Pennsylvania, 1(800)732-0999. Registration does not imply endorsement.
Mail your Application today!
For Office Use Only PRPS
2131 Sandy Drive
Date:__________________ Amount:___________
State College, PA 16803-2283
Method:________________ By:________ (814) 234-4272 Fax: (814) 234-5276 www.prps.org
Processed:______________