Porcelain Painters International Online (PPIO)
MEMBERSHIP APPLICATION

This application form is for
NEW MEMBERSHIP APPLICATIONS ONLY

If you need to RENEW YOUR
EXISTING ANNUAL MEMBERSHIP IN PPIO
click HERE to go to the
PPIO MEMBERSHIP RENEWAL APPLICATION form.

 

Important: Click Here for Application Instructions.

Entries with an asterisk (*) are required.

We have added boxes for your secondary address information (for those of you who have two residences and stay in each during different periods of the year). This information is not required for your membership application.  If you want PPIO to have the information, you should complete the secondary address information boxes on this form.
Application Date:
(MM/DD/YYYY or M/D/YYYY)

Email (*Required if you have an Email Address)
Don't forget the text after the @ sign)
(Maximum characters: 50)
*Last Name (Max. Characters: 20)
 *First Name (Max. Characters: 20)
*Street Address (Max. Characters: 100)
Include any apartment or unit number
*City or Town (Max. Characters: 40)
 Telephone
(Include Area code
Format as ###-###-#### or
whatever format your country uses)

USA? Please Check here (If in USA, No need to fill in Country and Location box)

USA Only Section

Complete boxes in this section for USA Only:

*State
(Required for USA Entries
Select your State from the list)
 *Zip Code
(Zip Required for USA Entries
Maximum Characters: 10)

OUTSIDE U.S.A.

Complete boxes in this section for Outside USA Only:

*Province or Location
(Maximum Characters: 50
Required for Out of U.S.A. Entries
Include any location code)

*Country
Please type the name of your COUNTRY
(Maximum Characters: 50
Required for Out of U.S.A. Entries)

 
Secondary Address Information (If Applicable)
Second Address (Max. Char. 100)
Second City (Max. Char. 40)
Second State (Max. Char. 20) Second Zip Code (Max. Char. 20)
Second Country (Max. Char. 50)
 

NOTE: If you would like to give additional information not provided for on this form,
you may email Marci Blattenberger at marci@ppio.com or rxguitar@comcast.net.
 

PAYMENT TYPE (Click the circle by one of the options below

Credit Card
(Click the Submit Button to complete Credit Card submission).
Upon completion, your credit card will be charged $32.00.
If you include your email address, you should receive an automatic email receipt for the credit card transaction.

Check or Money Order
Print this form and
mail it, with Check or M.O. ($32.00), payable to "PPIO" to:
Marci Blattenberger
PPIO
125 Vulco Drive
Hendersonville, TN 37075

Note: If check is from a Non-USA bank, please add $10 (our bank charges us $10 fee for non-USA bank checks)

IMPORTANT!(Do not click the Submit Button for Check/MO Payments)