Professional Pet Groomers Association of Manitoba Inc.

PPGAM Membership Renewal/Application Form

* Date:

* Member Since:

* Service(s) Offered:

* I Groom: Cats, Dogs, Other (specify)

* First Name:

* Last Name:

* Email Address:

Home Phone:

Cell Phone:

* Mailing Address:

* City:

* Prov/State:

* Postal Code/Zip Code:

* Business Name:

* Work Phone:

Website:

* Mailing Address:

* City:

* Prov/State:

* Postal Code/Zip Code:

* Nov 2011 - Oct 2012 Membership Payment Options:

$100 (+ Processing Fee) - PayPal

$100 - Money Order (Via Snail Mail)

$100 - Cheque (Via Snail Mail)

Money Order (In Person - at AGM)

Cheque (In Person - at AGM)

Cash (In Person - at AGM)

ONLINE PAYMENT OPTION (New Page Will Open)

*

Yes, I would like to receive my Newsletter via email.

I give permission for the PPGAM to provide my information as stated above to other members within the association on any official PPGAM marketing material.

* Send Membership Form To:

PPGAM Secretary

PPGAM Webmaster

* Indicates Response Required

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