20 21 PGI Membership Application: Office Use Only

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2021 PGI Membership Application

Please consider using the online membership system, visit www.pgi.org/member for more information.
The Pyrotechnics Guild International (PGI) is a non-profit fellowship of pyrotechnic enthusiasts founded in 1969,
incorporated in 1974 that is dedicated to the Advancement of Safety, Skill, and Artistry in Pyrotechnics through
Communication & Education, and to the Preservation of Pyrotechnics throughout the World.
Last Name First Name
Office Use Only
Mailing Address Amt:

Chk#
City State Zip/Postal Code
M/O#
E-Mail Country
Auth#
Primary Contact Number Alternate Contact Number
Pd By:

Employer Occupation Date:

How did you hear about us?

Date of Birth
Add to public mailing list?  Yes  No
Add to PGI Only e-mail list?  Yes  No Past Member? Yes  No
Full membership, with all privileges, applies to all members 18 or older. Fees are valid until 12/31/2021
+
Membership w/ Bulletin (must be at least 18) Junior $100 0 $ 0

Junior Membership w/ Bulletin + (must be under 21) $60 0 $ 0

Life Membership w/ Bulletin Life (must be at least 18) $2,500 0 $ 0

+ If you are under 18 and applying for a Junior membership, written permission from your parent or legal guardian is required

Payment Method  Check  Money Order  Visa  MasterCard  PayPal (paypal@pgi.org)


Credit and debit cards are welcome. Please do not send cash. Checks must be in US funds, drawn on a US bank, and payable to the PGI.
Card # CV Code Exp Date

Signature Date
Bruce Blom - $7500 showing.
Please sign whether or not you pay by credit card. “By signing above I agree to abide by PGI Bylaws and policies.” Bylaws available at www.pgi.org

Send completed form to:


Julie Wozniak
PGI Membership Services Manager Submit
1032 Georgetown Road
Michigan City, IN 46360
Tel.: (219) 872-2503
E-mail: membership@pgi.org

Members paying by Credit or Debit Card may mail or e-mail their forms.
1/8/21

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