Western Pyrotechnic Association

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WESTERN PYROTECHNIC ASSOCIATION 2013

NEW MEMBERSHIP AND RENEWAL APPLICATION

Click here to download the paper version of the membership application

Membership runs from January 1 through December 31 every year. There is no pro-ration or refunds made for partial year memberships. Membership is available to those 18 years of age and older. Decisions of the BOD and membership committee regarding membership are final.

Fill out this form ONLY if you intend to make payment online. If you plan to mail your payment, fill out this form, print it and mail it in with your payment enclosed. Thanks!

First name*:
Last name*:
Member#:
Street Address*:
City*:
Country*:
State*:
Province*:
Zip/Postal Code*:
Telephone Home*:	() -
Telephone Business:	() -
Occupation:
E-mail*:
Date of Birth*:	//

Member type*:	New Member $110 Renewing Member $80 Late Renewing Member $90 (not current in 2012) Student Member $50 Corporate Member $250 Lifetime Member $1200

Qualifications (for new members only)*:
A) I am a licensed Pyrotechnic Operator. You are required to send in a photocopy of your current license to forms@westernpyro.org.
License Type:
License #:
State of Issuance:
B) I am a current member, in good standing, of another Pyrotechnic organization. You are required to send in a photocopy of your current membership to forms@westernpyro.org. Please send immediately after submitting this form.
C) List two (2) current members of the WPA, in good standing, who will personally vouch for your character. The references will be verified.
Member Name:
Member Name:
D) If you do not meet the above qualifications, you can not apply online. You must submit a personally written letter explaining your interest in pyrotechnics and why you should be allowed to become a member. Please download the application form here.

	Spouse/Life Partner Member $50
Spouse/Life Partner Name:

Total Amount:	(Internet Processing Fee has been added.)

Billing address:	same as mailing
Street Address*:
City*:
Country*:
State*:
Province*:
Zip/Postal Code*:
Payment information:
Type of Credit Card*:
Credit Card Number*:
Expiration Date*:	/
Indemnification Member agrees to Indemnify and hold harmless the Western Pyrotechnic Association, Inc., each of it's members, officers, agents, employees, and successors from and against all claims, damages or injuries, direct or consequential rising out of any direct and/or indirect or collateral participation in the Western Pyrotechnic Association, Inc. activities by the undersigned, his or her spouse, or children, if any. Member also recognizes that violations and abuses of the Western Pyrotechnic Association, Inc. safety rules may result in suspension and possible revocation of the Western Pyrotechnic Association, Inc. membership. Member is also not prohibited from purchase/possession in any jurisdiction of pyrotechnic/explosive material.
I agree to the terms of indemnification described here.*:	yes