Name: (one per form)___________________________________________________________
Home Phone:_________________________ Fed Tax I.D. # __________________________
Studio / Business Name:________________________________________________________
Studio / Business Address:______________________________________________________
Date of Birth_________________________
I am a member of Professional Photographers of Iowa (circle one) YES NO
I am a member of Professional Photographers of America (circle one) YES NO
My PPA number is____________________
Degrees Held (circle all that apply)
CPP MASTER CRAFTSMAN IA FELLOWSHIP CERTIFIED ARTIST MASTER ARTIST
ACTIVE MEMBER / STUDIO__________ $79.00 SAVE $10.00 - REGISTER EARLY
After March 24, 2015__________________ $89.00
ASSOCIATE MEMBER_______________ $25.00
My signature on this application/renewal of membership with the NWIPPA, attest that I have read a copy of the constitution and bylaws of the association and will abide by the code of ethics. Upon being accepted as a member of the NWIPPA, my membership will be renewable each calendar year at the rates agreed upon by the current elected officers.
Please return this form along with payment to:
Jon Jamison All correspondence to membership is via e-mail.
PO Box 471 Please notify Jon Jamison, Sec-Treas., if
Perry, Iowa 50220 you would prefer notification by regular mail.