The Picture Archive Council of America

PACA
Application for International Membership 2010
Fee for International Membership is $500.00-USD

BOLD fields are required. Please provide the following information in its entirety.
Non-proficient English speakers please contact the membership committee for assistance.

Agency Name:
Place of Business/Address:


Place of Business/City:
Place of Business/State or Province:
Place of Business/Postal Code:
Place of Business/Country:
Mail Address, if other than above:


Mail City:
Mail State or Province:
Mail Postal Code:
Mail Country:
Phone:
FAX:
Email:
Website:
Date Business Started:	//
Number of FTEs:


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