PATA - Online Membership Management

PATA Micronesia Chapter – MEMBERSHIP APPLICATION

Welcome! Please complete and submit this brief application below.

This application form is for those who wish to join PATA Micronesia Chapter as new members or for those who want to add another business or organization to the membership. Please submit one application per business or organization entity. Individuals can join, as well. If you are looking to "Renew" your membership, please click here.

You will have these options to pay: 1) Pay Online (the best and fastest way to pay), or 2) Mail a Check, or 3) Hand Deliver a Check. Membership won't be active until we have received your payment. Online Payment would assure immediate membership. We accept most major credit cards and also PayPal. Thank you!

* Means Required Fields

Applicant's Information

First Name *

Middle Initial/Name

Last Name *

Email Address *

Confirm Email Address *

Telephone/Landline Number (Include: Country Code – Area Code – Number) *

Mobile/Cell Number (Include: Country Code – Area Code – Number) *

Which of these destinations in Micronesia do you work in/serve? *

Mailing Address

Street/PO Box *

City/Village *

State/Territory/Island *

Country *

Zip Code/Postal Code *

Membership Category

Membership Category: *

Sub-Category/Fees: *