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2012 Manufacturer Group Purchase Option

Complete the form below to purchase one of the bundled individual membership options with PMRG. This option is only available to manufacturer-side companies.

Once the membership bundle is purchased on behalf of the organization, the package contact will receive an e-mail confirmation with simple instructions to share with the appropriate employees to activate their individual PMRG memberships.

The following are the tiered dues options for the 2012 bundled membership purchase program.
All memberships created under these packages will be in effect until December 31, 2012.

# of Members	Annual Dues
4 Members or Less	$500
5 - 10 Members	$750
11 - 25 Members	$1,875

For questions, please contact Andrea Bennett at andrea@pmrg.org or 407-366-0143

Package Information

Company Name:

Street:

City:

Country:

Region:

Postal Code:

Package Contact Name:

Package Contact Email Address:

Package Contact Telephone:

Group #:

Tiered Membership Level:

Payment Information

Credit Card First Name:

Credit Card Last Name:

Credit Card Billing Street:

Credit Card Billing City:

Credit Card Billing Country:

Credit Card Billing Region:

Credit Card Billing Postal Code:

Card Type:

Credit Card Number (no spaces):

CCV Code:

Expiration Month:

Expiration Year:

Membership Terms

I understand all PMRG memberships are on a Calendar Year basis. Each membership created under this package will be in effect through 12-31-2012.
Thereafter, term and dues are NOT prorated based on join date.

I AGREE:

Contributions or gifts to PMRG are not tax deductible as charitable contributions for income tax purposes. However, they may be tax deducible as ordinary business expenses subject to restrictions imposed as a result of PMRG's lobbying activities. PMRG estimates that the non-deductible portion of your dues in 2012 allowed will be 100%.