Name: (one per form)___________________________________________________________

Home Address:_______________________________________________________________

____________________________________________________________________________

Home Phone:_________________________ Fed Tax I.D. # __________________________

 

Studio / Business Name:________________________________________________________

Studio / Business Address:______________________________________________________

____________________________________________________________________________

Business Phone:_______________________________________________________________

 

E-Mail Address:_______________________________________________________________

Web site:_____________________________________________________________________

 

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

 

Member Status

ACTIVE MEMBER / STUDIO__________ $79.00      SAVE $10.00  -  REGISTER EARLY

After March 24, 2015__________________ $89.00

 

ASSOCIATE MEMBER_______________ $25.00

STUDENT___________________________$45.00

 

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.

 

Signature____________________________   Date___________________________________

 

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.