Corporate Membership Applications

Click HERE to download a PDF of our membership application. Please email completed forms to pdetrade@comcast.net.

 

    Corporate Membership Application

    The following information is required to have the PDE Board of
    Directors consider your application for membership in the PDE.

    Company Name:

    Address Line 1:

    Address Line 2:

    City:

    State:

    Zip Code:

    Website:

    Nature of Business:

      Pharmaceutical Manufacturer  Chemical Supplier 
     Allied Trade (Specify)

    Type of Organization:

      Corporation  Private  Publicly Held  Division 
      Name of Parent Company: 
      Individual 

    Company Information

    Describe key product line(s) or service(s) provided:

    Interest in the PDE

    Please state why your company is interested in joining the PDE:

    Company Representatives

    Please give the following information for the persons who would represent your company with the PDE as:

    Official Correspondent: (Primary contact)

    Name:

    Title:

    Preferred Mail Address:

    City:

    State:

    Zip Code:

    Office Phone:

    Cell Phone:

    E-Mail Address:

    Corporate Dues entitles every employee, of a member company, to participate in all of the PDE’s annual events at the member rate

    Please list employees who will participate in company membership

    Name:

    E-Mail Address:

    Name:

    E-Mail Address:

    Name:

    E-Mail Address:

    Name:

    E-Mail Address:

     

     

    $595 payable to “PDE” and will be billed after membership approval.