PSA Membership Form

Name:  

Department:  

Box #:  

Phone #:  

E-mail Address:  

Birth date:  

 We encourage you to serve on a committee.  This helps in achieving PSA’s mission to raise funds for charitable organizations.  Please check any that you are interested in.  

 Bylaws

Charitable

Courtesy

Membership

Nominating

Professional Development

Program Committee

PSA History  

Public Relations & Newsletter

Ways & Means

  Membership Dues:

  Dues are $10.00 annually

 Dues become payable on June 1 –June 30 

After June 30 dues are $12.50

Complete this form and mail check made payable to PSA

Betty Ann Proffitt, Treasurer

PO Box 70550