MEMBERSHIP APPLICATION FORM – Pest Management Association

Name of the firm:*

Landline Office No.

Mobile*

Email*

Address*

Authorized Representative:*

Title/Designation:*

The Firm Was Established Under the Present Ownership in (Month/ Year )

The Firm IsIndividually OwnedA PartnershipA Corporation

Qualification with Experience of Authorized Representative:

Qualification*

Experience*

(Attach Copy of the INSECTICIDE LICENCE)

References of Any PMA Membersas Sponsorship :

1. Name:*

PMA No.*

2. Name:*

PMA No.*

If Elected To Membership, I/We Agree To Company With The Code Of Ethics And Also Agree To Uphold The Purpose, Mission And Other Policies Of The Association. I/We Understand That The Membership Does Not Become Effective Until Notification Is Received From The Association And Once My/Our Membership Is Accepted I/We Shall Abide By Other Terms And Conditions Of The Membership, So As To Uphold The Image Of The Association. Besides This, I/We Also Understand That Any Act Contrary To The Association Becomes Liable For Either Suspension Or Revocation Of My/Our Membership.