PA-PLS Sign Up Form

Please fill out the form below to register for membership in PA-PLS. All fields are required.

Membership Fee (7/1/09 to 8/31/11)…Free (Target future fee $30-$50)

Name

License Number

States licensed as a PLS

States licensed as a PE

Company Name

Company Address

Company Telephone

Company Fax Number

Check One:
Sole Owner
Partnership/Corp.
Employee

County you reside in

Name of City / Borough / Township you reside in

Choose the type of municipality you reside in:
City
Borough
Township

Your E-Mail Address

Your Company Website Address

Username

Choose a Username for your PA-PLS account

Password

Choose a Password for your PA-PLS account

Would you like to be listed as a Land Surveying Company with your address, phone number, e-mail and/or website address in the public section of the www.PA-PLS.org website for advertizing purposes? Please check one:

Yes
No

To help keep dues low, we will allow a few vendors to advertise special deals and promotions directly to our Members. Would you prefer to have these notices sent directly to you via e-mail or placed in the Members-only section of the PA-PLS website?

Direct via E-mail:
Yes
No

On the PA-PLS site:
Yes
No