Global Pest Management Coalition: Membership Application

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* 1. Please enter the following information for your organization's designated representative:

Given Name

Family Name

Organization/Company

Title

Email Address

Phone Number (include country code)

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* 2. Please enter the following information for your organization:

Organization/Company Name (Native Language)

Organization/Company Name (English)

Address

City/Town

State/Province

ZIP/Postal Code

Country

Company Email

Website

Please provide the following demographic information for your organization (questions 3-7):

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* 3. Number of members

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* 4. Please check if your membership is individuals or companies.

Individuals

Companies

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* 5. Type of members permitted to join

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* 6. Country/Area represented by organization

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* 7. Annual Revenue (please state currency)

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* 8. Please list other pest management associations your organization is affiliated with:

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* 9. Please select your membership level below.

Association Membership ($500 USD yearly membership fee)

Corporate Membership ($1,000 USD yearly membership fee)