PMA Membership Application Form
People's Memorial Association, 1801 12th Ave, Ste A, Seattle WA 98122

Applicant 1

 
Prefix First Name Middle Name Last Name Suffix Gender
Shipping address (membership packet will be mailed here): City State Zip
Phone Email address: SSN. (last four, optional) Birth Date (mm/dd/yyyy)
C/O (If someone else is receiving mail at above address on behalf of the member):
Applicant 2

 
Prefix First Name Middle Name Last Name Suffix Gender
Shipping address (membership packet will be mailed here): City State Zip
Phone Email address: SSN. (last four, optional) Birth Date (mm/dd/yyyy)
C/O (If someone else is receiving mail at above address on behalf of the member):
Submitted by: Date: 11 Mar 2010 Phone:
Relationship to applicant:
Application fees are non-refundable and non-transferable.
Cost (application fee): 1 applicant $25 basic/$50 Sustaining membership    2 applicants $50 basic/$100 Sustaining
(Sustaining memberships are the usual $25.00 application fee and a one time donation to the Association of $25.00 for a total of $50.00 per applicant. The donations help support PMA's continuing efforts to educate consumers on end-of-life issues. They are not tax deductible.)
Please choose type of membership:  
Credit card information:
Visa MasterCard --- Account # - - -
Credit card expiration: Month Year
Your name as it appears on your credit card:
Blling Address: City State Zip