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Pandemic Planning

 

Membership Information

This page has been created to allow PEP members to complete their membership applications online if you are paying by credit card.  Please complete all applicable information below.  You will need to go to a separate page by clicking on the Paypal link below. This registration page will submit your information to a membership database and will produce a confirmation page that will show you the information you entered.  Please print that page as confirmation that your application was completed.  You will need to return to this page after submitting your membership application to pay for the membership via credit card.  If you have any problems or questions, please e-mail or call Nick Crossley ( ncrossley@jocogov.org or 913-715-1007 ).

If paying by Check: Download the application and mail your check to Joyce Cheng prior to the your membership becoming valid.  You may download the membership application form in PDF format or Microsoft Word format below.  Ms. Cheng's mailing information is on the membership application.  Only use the online registration if you are paying by credit card.

Membership Application (.pdf)

Membership Application (.doc)

PEP Brochure (.pdf)

Code of Ethics (.pdf)

Please provide the following member contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
FAX
E-mail
Website

Choose one of the following options for membership type:


Choose one of the following options:


If purchasing a corporate membership, please list additional members below:

(List Name, Phone & E-mail (separate by comma's) for all additional organization members beyond primary contact)






I have reviewed the PEP Code of Ethics and agree to abide by them: (must be completed)

Yes
No

Membership Fee - $53.00 ($50 + $3 processing fee.  You will be directed to a secure purchasing page on the Paypal website)

Copyright © 2005 [Partnership for Emergency Planning]. All rights reserved.
Revised: 04/25/08