PENNSYLVANIA POETRY SOCIETY, INC. - Membership Application
Steps: Open window fully. Complete form. Print form. Attatch a check for the appropriate amount payable to PPS Inc.,marked "Dues" or "Patron." Mail the form and check to the address below:

Carole Hodell, PPS Treasurer
271 Bellaire Park Rd.
Carlisle, PA 17013

Name:
Address:
Address:
City:
State:
Zip:
Pen Name:
Telephone:
E-mail:

Type of Membership: (check one)
Regular @ $17.00 [**]
Patron @ $22.00+ [**] 		Membership Status: (check one)
Member-at-Large
Chapter Member:

** New members who join after May 1st: Your membership will be paid-up to September 30th of the following year,
but you will need to add $6.00 to the "dues" or "patron" fees to receive PRIZE POEMS of the current year.
Check for current edition of PRIZE POEMS.

New members: please state who encouraged you to apply for membership:
Optional: Attach a resume of your accomplishments and goals in poetry.