Manufacturer / Supplier Membership Application

Manufacturer / Supplier – Membership Application

Company/Supplier Application – Suppliers, manufacturers and other companies in the pedorthic industry

…..* Voting rights through Supplier/Manufacturer Liaison on PFA’s Board of Directors
…..* Discounts on all PFA educational events (Booth and Registration)
…..* Discounts on Resource Center Bookstore purchases
…..* Discounts on car rentals
…..* Online Subscription to Current Pedorthics Magazine
…..* Company listing, in the Product Reference Guide of each issue of Current Pedorthics magazine and an identical listing on both (CAN and USA) PFA websites.

Membership Fee $500 plus tax per year (pro-rated)
Membership year runs May 1st – April 30th

Date of Application*
MM slash DD slash YYYY
Name*
First Last
Email*
Enter Email Confirm Email
Cell Phone*
Company Name*
Position in the Company*
Company Address*
Street Address Address Line 2 City Province Postal Code
Company Phone*
Company Website*
Logo- Upload your logo to be placed in the online and magazine listings
Max. file size: 128 MB.
Company Description - Please add the company description you would like to have entered in the online supplier database and in the Current Pedorthics online Bi-monthly publication.
Manufacturer / Supplier Membership Fee (Pro-rated)*
Please select the month this application is being submitted to ensure your membership rate is pro-rated.
Subtotal
$ 0.00 CAD
Total
$ 0.00 CAD
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Name
This field is for validation purposes and should be left unchanged.