PAC Membership Application Form

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PAC Membership Application Form:

(Fields marked * are required.)

Mr. Mrs. Ms. Dr.

*First Name:

Middle Initial

*Last Name:

*Organization:

Position/Title:

*Street Address:

*City:

*State/Province:

*Zip/Postal Code:

*Country:

*Telephone:

Fax

*E-mail:

Web Site:

*Primary Activity (please check one)

	Primary Producer
	Secondary Producer (supplier, equipment manufacturer, services)
	Processor
	Marketing
	Trade Association
	Educational Institution
	Federal Government
	State/Local Government
	Tribal
	Research Institution
	Advisory/Extension/Outreach
	Other

Field(s) of interest (check all appropriate choices)

	Marine Fish
	Freshwater Fish
	Ornamental Fish
	Crustaceans
	Shellfish
	Aquatic plants and algae
	Other

*Membership Type (check one only)

Primary $250

*Nominating Organization:
I agree that I have read, understand, and support the mission and goals of the Pacific Aquaculture Caucus and hereby apply for Primary Membership. A Primary Member is an individual nominated by any registered business, association, or organization active in the development of aquaculture or its associated fields and who pays the appropriate annual dues. A Primary Member is eligible to serve as a director and officer of PAC. A check for $250 will be sent to PAC.

Secondary $25

I agree that I have read, understand, and support the mission and goals of the Pacific Aquaculture Caucus and hereby apply for Secondary Membership. A Secondary Member is anyone having a genuine interest in the mission and goals of PAC and who pays the appropriate annual dues. A Secondary Member is not eligible for election as an officer of PAC, but may serve as a director-at-large or committee member. A check for $25 will be sent to PAC.

Comments:

PAYMENT

Your membership will not be activated until a check for the appropriate dues has been received by PAC and your application has been reviewed and approved by the Board of Directors.

Please make checks payable to "The Pacific Aquaculture Caucus" and send to:

PAC Treasurer
Attention: Dan Swecker
10420 173rd Ave SW
Rochester, WA 98579