To
apply for membership, print this form our and send with your
dues to:
PA State Showmen's Assoc.
P.O. Box 5
New Tripoli, PA 18066
DUES MUST ACCOMPANY ALL APPLICATIONS
In Applying for membership in the
P.S.S.A., I do hereby agree to abide by the laws of the constitution of this Association, in so far as they pertain to me personally and to work towards those ends and purposes which will best serve the interests of all members.
Name:
____________________________________
Address:
____________________________________
City,
State
Zip Code:
____________________________________
Phone:
____________________________________
Date:
____________________________________
Business
Name:
____________________________________
County
Twp.:
____________________________________
Date of
Birth:
____________________________________
Do you belong to any other Showmen's Club or Auxiliary?
Yes
No
In what capacity are you allied with Show
Business?
Carnival Owner
Carnival
Employee
Allied Industry
Direct Sales
Food Concessions
Games Concessions
Fair
Junior Member
Supplier
Entertainment
Booking Agent
Ride Owner
Have you ever been denied membership in this organization or in any other Showmen's Club or been dropped from the same?
Yes
No
As a member, I intend to vote in the ________________
Chapter of the State. (insert one, Eastern or Western)
I hereby enclose:
2009
Regular Dues - $30.00
2009 Junior Membership- Age 16 & 17
- $15.00
Signature of Applicant
____________________________________
