PMDA MEMBERSHIP APPLICATION

Please accept this application in the PhotoImaging Manufactures &
Distributors Association, Inc. (PMDA).  We have attached our check
covering membership dues for one year in accordance with the dues
schedule printed below.

Name of Company________________________________________________________

Address_________________________________________________________________

City ________________________________________  State __________ Zip ________

Manufacturer/Distributor_____________________ Web Site ______________________

Name of the person who will represent company ________________________________

Phone _____________________Fax ___________________Email__________________

Signature_______________________Title __________________________Date_______

(Please Check One Below)

        __Full Member $1,500               __Associate Classification $750

Full Membership                                                                        $1,500 annually

Associate Classification (non voting)                                              $750 annually
Publications, agencies, analysts and other non-manufacturing service providers

**PMDA accepts Mastercard, Visa & American Express**
Contributions or gifts to PMDA are not tax deductible as charitable contributions.

However, they may be tax deductible as ordinary and necessary business expenses.
(This IRS regulation also applies to PMDA dues.)

Please fax, mail or email this application to:
PMDA, 109 White Oak Lane, Suite 72 F, Old Bridge, NJ 08857, Attn: Genevieve Christo
Phone: 732-679-3460, Fax:     732-679-2294  christo@pmda.com