Association Executives Council
Association Executives Council 2017 Membership Application CONTACT INFORMATION Name: Title:
Chapter:
Address:
City, State, Zip:
Phone:
Fax:
Email Address:
Website Address:
How long have you been a PHCC Chapter Executive:
Today’s Date:
Please answer the following questions: 1. Do you have a newsletter? □ Yes 2. Do you have a magazine? □ Yes 3. Do you have an annual meeting/convention? □ Yes 4. Do you hold educational seminars? □ Yes 5. Do you hold social events? □ Yes 6. Do you hold golf outings? □ Yes 7. Do you have an apprenticeship training program? □ Yes 8. Does your chapter address legislative issues? □ Yes Signature of Applicant:
□ No □ No □ No □ No □ No □ No □ No □ No
□ State
□ Local
If yes, how frequently is it published? If yes, how frequently is it published? If yes, how frequently?
Printed Name:
2017 PHCC National AEC Investment Regular Primary Member: $175.00
Second Member from same Chapter: $75.00
Payment Information: □ Check or money order enclosed (payable to AEC) Amount $ Check one: □ Visa □ MasterCard □ AMEX □ Discover Credit Card Number:
Exp. Date:
Name on Credit Card:
Cardholder Signature:
CSV:
The AEC The Association Executives Council of PHCC is an “association within an association.” Its members are the paid staff of local, state and regional PHCC-National Association affiliated associations. Our mission is to Advocate, Educate and Communicate to help better the PHCC on all levels. Please return this application to Elicia Magruder, [email protected] Questions? Call 800-533-7694 PHCC – National Association | 180 S. Washington Street, Ste. 100 | Falls Church, VA 22046 | P: 800-533-7694 | F: 703-237-7442
Chapter:
Address:
City, State, Zip:
Phone:
Fax:
Email Address:
Website Address:
How long have you been a PHCC Chapter Executive:
Today’s Date:
Please answer the following questions: 1. Do you have a newsletter? □ Yes 2. Do you have a magazine? □ Yes 3. Do you have an annual meeting/convention? □ Yes 4. Do you hold educational seminars? □ Yes 5. Do you hold social events? □ Yes 6. Do you hold golf outings? □ Yes 7. Do you have an apprenticeship training program? □ Yes 8. Does your chapter address legislative issues? □ Yes Signature of Applicant:
□ No □ No □ No □ No □ No □ No □ No □ No
□ State
□ Local
If yes, how frequently is it published? If yes, how frequently is it published? If yes, how frequently?
Printed Name:
2017 PHCC National AEC Investment Regular Primary Member: $175.00
Second Member from same Chapter: $75.00
Payment Information: □ Check or money order enclosed (payable to AEC) Amount $ Check one: □ Visa □ MasterCard □ AMEX □ Discover Credit Card Number:
Exp. Date:
Name on Credit Card:
Cardholder Signature:
CSV:
The AEC The Association Executives Council of PHCC is an “association within an association.” Its members are the paid staff of local, state and regional PHCC-National Association affiliated associations. Our mission is to Advocate, Educate and Communicate to help better the PHCC on all levels. Please return this application to Elicia Magruder, [email protected] Questions? Call 800-533-7694 PHCC – National Association | 180 S. Washington Street, Ste. 100 | Falls Church, VA 22046 | P: 800-533-7694 | F: 703-237-7442
