Please complete the following membership information and submit a check payable to "CEA/PA" to:

Lainey Becker, CEA/PA Membership Chair
Pittsburgh Technical Institute
1111 McKee Rd.
Oakdale, PA 15071
Phone: (412) 809-5212
Fax:     (412) 809-512
Email: becker.lainey@pti.edu

 

CEA/PA Application for Membership  2007-08
Please check one of the following:
Institutional Membership - $175 (Complete Sections A & B below) Includes three members.  Add $20 for each additional member.  Includes a PAACE membership for the institutional contact person.
Individual Membership - $100 (Complete Section B below) Includes a PAACE membership.
Retired - $50 (Complete Section B below) Does not include a PAACE Membership
Associate/Student Membership - $25 (Complete Section C below) Does not include a PAACE membership.
Section A:
Complete for Institutional Membership
Name of Institution:
Address:
City, State, Zip
Section B:
Complete for Institutional Membership
May list three members.  The first member listed will be the institutional contact person.
Complete for Individual and Retired Membership - list one member.
Member's Name #1:
Professional Title:
Phone:
Fax:
Email:
Address:
City, State, Zip:
Member's Name #2:
Professional Title:
Phone:
Fax:
Email:
Address:
City, State, Zip:
Member's Name #3:
Professional Title:
Phone:
Fax:
Email:
Address:
City, State, Zip:
Section C:
Complete for Associate/Student Membership
Member's Name:
Professional Title:
Phone:
Fax:
Email:
Address:
City, State, Zip:

Comments or questions:
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