Corporate Membership Application

Name of Business: 

Business Street Address: 

City:    State:  Zip:

Company Website Address:

Contact Person: 

Email Address of Contact:

Describe your business (include your target population):

Have you been a corporate member previously?    

For how many years?    

After you have submitted this form, your information will be transferred electronically to our Corporate Member Liaison. If your company is approved for membership, you should receive an invoice in the near future to remit with payment.

Thank you for choosing to become a part of our strong and growing association. We look forward to a long and productive partnership with you.

©2006 POPAI
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Probation Officers Professional Association of Indiana, Inc.
P.O. Box 44148
Indianapolis, IN 46244