FPDA 2018 Dues Payment

Note: Please use the TAB key not the ENTER key to move down the registration form.

Basic Information

First Name
Last Name
Company Name (as it appears on the invoice):
Address:
City:
State/Providence:
Zip/Zone:
Country:
Phone:
E-Mail Address:

Membership Renewal

Distributor
Associate Dues -Manufacturer/Service-Vendor/Publication
 
Please select your dues level according to total number of employees.
Distributor Dues:
Associate Dues:

BRANCH annual renewal fee ($150.00 per branch) for additional locations only. If you only have one company location a branch fee is not owed. Please list branch location(s):
Example:
ABC Company
111 Distribution Lane
Annapolis, MD 21403
Branch Location(s):
Please total up your number of branch locations
x 150 = Amount Due $
 (Click here for fee chart.)

Scholarship: In recognition of Tom Ralls' strong support of the ongoing professional development of industry executives, the Tom D. Ralls Memorial Scholarship is awarded annually to an FPDA distributor member to fund tuition costs for attendance at the University of Innovative Distribution. If your company would like to make a tax-deductible contribution to the Tom D. Ralls Memorial Scholarship Fund, simply add the donation amount of your choice to your total invoice. Thank you!
Donation Amount
   - denotes required fields