2020 Annual Membership Registration/Renewal

If you wish to mail in your Annual Registration/Renewal, please print THIS FORM and mail it, along with your check, to:

PFMA
c/o Nittany Co-Op
226 East Nittany Avenue
State College, PA 16801

Otherwise, please complete your Annual Registration/Renewal using the online form below.

Donation Amount:

$ 25.00

Automatically renew membership

Member Details

First Name *

Last Name

Email Address *

Phone

Agency *

Department

Title

Facility/Office Street Address

Facility/Office City, State Zip

Retiring soon? Please include a personal email if you wish to remain a member.

Credit Card Info

This is a secure SSL encrypted payment.

Card Number *

CVC *

Cardholder Name *

Expiration *

Billing Details

Country *

Address 1 *

Address 2

City *

State *

Zip / Postal Code *

Membership Fee $25.00 One Time