Retired Membership Application

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


    Address Line 1:

    Address Line 2:



    Zip Code:


    Company or University Affiliation:

    Nature of Affiliated Organization:

      Pharmaceutical Manufacturer  University/College 
     Allied Trade (Specify)

    Type of Organization:

      Corporation  Private  Publicly Held  Sole Proprietor  University/College  Division 
      Name of Parent Company: 


    Company University Course of Study Information

    As applicable, describe key product line(s) or service(s) provided or course of study for student

    Interest in the PDE

    Please state why you are interested in joining the PDE:



    Yearly membership dues are:
    $75 Retired
    payable to “PDE” and will be billed after membership approval.