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://potatoassociation.org

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,  and APJ from 1923 are available online at [http://www.springer.com/life+sci/plant+sciences/journal/12230]; electronic access to the European Assoc for Potato Research's journal, "Potato Research", reduced registration rates and voting rights at the Ann Mtg, access to the PotatoNet e-mail/chat room as well as additional benefits. As a Sustaining Member, you receive everything an Individual member receives plus additional benefits meant for your upper level membership only. Check the PAA website or contact the home office. Contact information above.

  ___ Individual  $ 100.00 Total: $ 100.00
 ___ Grad Student**  $  20.00**  Membership includes all rights as Individual member but electronic access of AJPR only.  Total: $   20.00
 ___ Sustaining*** $ 500.00  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.
___ An additional gift to the [  ] PAA Endowment; [  ] Frank Haynes Grad Student Res Comp Awd: $________

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:______________________________________________________________
Company:______________________________________________________________________
Address:_______________________________________________________________________
__________________________________________ City: ________________________________
Zip / Country Code: ________________________  Country:_____________________________
Phone: _______________________________  Fax:_____________________________________
E-mail:________________________________  Website:_________________________________

SECTION AFFILIATION(S):  [  ] Breeding & Gen   [  ] Certification  [  ] Extension [  ] Physiology
[  ] Production & Management   [  ] Plant Protection   [  ] 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.