The Potato Association of America "Membership Application"

PLEASE NOTE: ALL MEMBERSHIPS RUN FROM JANUARY 1ST TO DECEMBER 31ST NO MATTER WHEN YOU SEND IN YOUR MEMBERSHIP FEES.

The Potato Association of America
The University of Maine
5719 Crossland Hall, Room 220
Orono, ME 04469-5719
Phone: 207-581-3042    Fax: 207-581-3015
E-mail: umpotato@maine.edu
Website: http://www.umaine.edu/paa

Date:____________________________
CHECK ONE: 

____   New Member  _______     Renewal*   (ID #______  )

Membership includes six (6) issues of the American Jnl of Potato Res (publ bi-monthly); electronic access to the AJPR, all back issues [from 1923-forward] are available online on SpringerLink.com [http://www.springer.com/life+sci/plant+sciences/journal/12230]; reduced registration rates and voting rights at the Annual Meeting, automatic access to the PotatoNet mailing list/chat room as well as additional benefits which may be found on our website. As a Sustaining Member, you receive everything an Individual member receives plus additional benefits meant for your category of membership only. Check the PAA website or contact the home office for details.

* Add $45 for Air Mail postage. ONLY ADD POSTAGE IF YOU LIVE OUTSIDE OF THE UNITED STATES & CANADA

  ___ Individual  $100  [+ $ 45 (postage*) =   Total: $________
 ___ Grad Student**  $20**  Membership includes online version of AJPR only, NO printed issues supplied, but available for an additional fee. Contact PAA Office for details.  Total: $________
 ___ Sustaining*** $500 [ALL POSTAGE IS INCLUDED] Total: $ 500.00

The PAA Insider Newsletter (publ. Quarterly) will be delivered by e-mail to the address provided by the member or by US mail for $10/year to help cover postage & processing fees. If neither option is selected, you may read it on the PAA website once it has been published. [http://www.umaine.edu/paa/paainsiderindex.htm]

___ E-mail my PAA Insider to: _________________________________________
___ NO, mail my newsletter, enclosed is $10 to cover postage & handling.
___ Send copy of Membership Directory. I have enclosed $10 to cover the cost.
___ A gift to the [  ] PAA Endowment; [  ] Frank Haynes Grad Student Res Comp Awd: $                    
        In Memory Of: __________________________   In Honor Of: ________________________________

CIRCLE Credit / Debit and Card Info: VISA / MC. The CCV [Credit Card Validation] number is the 3-digit number on the back in the signature block. [Must have to process]

Card #:______________________________   Exp. Date:__________ CCV #: _________
Card Holder Name:___________________________ E-mail: __________________________
 **Requires Signature of Advisor:______________________________________________
***Contact Person:__________________________________________________________

New Member Name:______________________________________________________________
Address:______________________________________________________________________
______________________________________________________________________________
Zip / Country Code: ___________________________  Country:__________________________
Phone: _______________________________  Fax:_____________________________________
E-mail:________________________________  Website:_______________________________

SECTION AFFILIATION(S):  [  ] Breeding & Genetics   [  ] Certification  [  ] Extension & Teaching  [  ] Physiology

[  ] Production & Management  [  ] Plant Protection (Pathology / Entomology / Weeds)  [  ] Utilization & Marketing

Please make payments in credit cards [Mastercard or VISA only], Int'l Money Orders, U.S. Money Orders or a Check Drawn on a U.S. Bank made payable to: POTATO ASSOC. OF AMERICA. Thank you!