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Corporate Membership Application

Upon receipt of dues, designated representatives* will be placed on the mailing list immediately. Information supplied below will be included in the Membership Directory, unless otherwise specified.

Company/Organization
Address
City
State   Zip
Business Type

*Designated Representatives: All employees receive Society discounts, but only designated representatives receive mailings and listings in the Membership Directory.

Key Contact for membership changes and renewals

Key Contact Name
Title
Telephone   Fax
E-mail

Membership Dues:
please select your desired membership level from the list below.

$5000 Benefactor 10 representatives
$2500 Patron 6 representatives
$1000 Contributor 4 representatives
$500 Member 2 representatives
$250 Academic/Civic Member 1 representative

Dues are for one calendar year from the date of application/renewal.

To complete your application, dues payment may be made by major credit card via telephone.
Please contact the JASP at (412) 433-5021 to complete your application.

Representatives:
Each membership category may designate the following number of representatives (including the Key Contact)
Benefactor - 10, Patron - 6, Contributor - 4, Member - 2, Academic/Civic Member -1

Please provide information for each designated representative below.

Contact Name
Title
Telephone
Fax  
E-mail
Contact Name
Title
Telephone
Fax  
E-mail
Contact Name
Title
Telephone
Fax  
E-mail
Contact Name
Title
Telephone
Fax  
E-mail
Contact Name
Title
Telephone
Fax  
E-mail
Contact Name
Title
Telephone
Fax  
E-mail
Contact Name
Title
Telephone
Fax  
E-mail
Contact Name
Title
Telephone
Fax  
E-mail
Contact Name
Title
Telephone
Fax  
E-mail
 

 

Japan-America Society of Pennsylvania • 600 Grant Street, Room 444 Pittsburgh, PA 15219-2703
Tel. 412 433-5021 • Fax. 412 433-5020 • jasp@us-japan.org

Japan-America Society of Pennsylvania • 600 Grant Street, Room 444 Pittsburgh, PA 15219-2703
Tel. 412 433-5021 • Fax. 412 433-5020 • jasp@us-japan.org