3899 North Front St., Harrisburg, Pa. 17110 · Phone: (717) 703-3000 · www.panewsmedia.org
AFFILIATE MEMBERSHIP APPLICATION
I (we) here by apply for Afliate Membership in the Pennsylvania NewsMedia Association, subject to conrmation by the PNA Board
of Directors and Members. Afliate membership applications are accepted from any individual, company or organization that
furnishes machinery, equipment, supplies, or services to the news media industry. This is a continuing membership to run consecu-
tively from year to year without the necessity of a yearly renewal. An afliate member may withdraw from the Association by
presenting PNA a written statement or resignation. Membership privileges in PNA may be withdrawn as set forth in the bylaws.
Date of Application:
______________________________
Company: ________________________________________________________________ Date Established: _____________________________
Name of Applicant: ___________________________________________________ Title: _______________________________________________
Email Address: _____________________________________________________________________________________________________________
Key Contact: _________________________________________________________ Title: _______________________________________________
Email Address: _____________________________________________________________________________________________________________
Company Address: _________________________________________________________________________________________________________
City: _____________________________________________ State: __________ Zip: ________________ County: _______________________
Main Phone: _____________________________________________ Main Fax: _____________________________________________________
Website: ___________________________________________________________________________________________________________________
Describe the nature of your business or profession and the product(s) or service(s) your company sells to newspapers : ___________
____________________________________________________________________________________________________________________________
List three Pennsylvania newspapers that your currently work with or sell product(s) to:
1. _____________________________________________________________________
2. ____________________________________________________________________
3. _____________________________________________________________________
Membership Type: For-prot rm, corporation or organization Non-prot rm, corporation or organization
ANNUAL DUES: $400
No payment is necessary at this time.
Please return the completed application form and a one-time-only application fee of $25, which is non-refundable, to the PNA ofce,
keeping a duplicate copy for your records. Upon membership acceptance, the $25 fee will be credited toward your dues. Please
include 3 promotional brochures or information sheets describing your company and its goods and services. Thank you for applying
for membership. Please return this completed form to the address below.
Authorized Signature: ______________________________________________________________________________________________________
Print Name: ________________________________________________________________________________________________________________
For question, contact Zeddie Neidig, Manager Meetings & Events, at (717) 703-3034 or zeddien@pa-news.org.
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