Membership Application Form

To join PSRF or renew your membership, complete the form and click the "Register Me" button at the bottom
of the page.

Payment of Dues
You can pay the membership dues by check or via our website using PayPal.

•   When paying by check, be sure to include a copy of this invoice complete   with your name and contact information, so we know to whom the membership   belongs.

   Please mail your membership payment to:

   PSRF Membership
   P.O. Box 926
   Mercer Island, WA 98040

   Please make checks payable to "Puget Sound Research Forum"

   Please note that if your check is returned for insufficient funds, you will be  responsible for the return check processing fee or any other fee which the  bank may charge PSRF.

   If you would prefer to pay using a credit card (via PayPal) that option will  appear after you submit this application form.

PSRF membership is for an individual, not a company.

Membership password:
Once we receive your payment, a PSRF volunteer will email you the membership password so that you can access the "Members Only" section of the website. Please note that if you pay online with PayPal, you will not receive an automatic reply from the system, but will receive the password in an email from our Membership Committee within 24-48 hours.

Having trouble with this form?
If you are having trouble submitting the application form, please be sure you have filled in every box in the membership information section, even if it indicates it is not required.

Puget Sound Research Forum is a 501c6 non profit association.

* Required.

Member Info

First Name * Fax Last Name * Address * Title City * Company State * AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Business Phone * Zip * Home Phone (will not be published) Email Address * Does PSRF have your current contact information (included in Membership Renewal email from PSRF)? Yes No Unsure

Membership

Are you a:   New Member or Renewal Dues: $85 (September 2010 - August 2011) $85 Membership $35 Student Membership (full time student, not employed in market research)

Other

How did you first learn about the PSRF? PSRF Member PSRF Website Friend/Colleague Other: In what industrty do you currently work? Market Research - Full Service Market Research - Consultant Advertising/Public Relations Communications Education Finance Health Care High Tech Manufacturing Non-Profit Print/Broadcast Media Public Sector Not Employed/Retired Other... Other: What research related activities are part of your current job? What topics/speakers would you like to hear about at our monthly meetings? Enter Code Shown Above:

 

 

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