The Pesticide Stewardship Alliance
Membership Application/Renewal:
September 1, 2016 August 31, 2017



(fields in red are required)
STEP 1. Contact Information for Individual or Organization Member
Name
Title
Company/Business
Email
Phone
Address
City
State/Prov
Postal Code
Country

 

 
STEP 2. Membership
Membership Type
Individual Membership/Renewal – $75

Organization – $200

MEMBER NAME 2: (name of person
NOT organization)

Email:

Phone:

Affiliation:

MEMBER NAME 3: (name of person
NOT organization)

Email:

Phone:

Affiliation:

Retired Membership/Renewal – $35
Student – $25
     
Affiliation of Membership: Each member please select one of the following areas of affiliation that represents your primary personal/professional area of focus within TPSA.

MEMBER'S NAME:
(name of person
NOT organization)

Choosing one affiliation per member does NOT prohibit any TPSA member from being actively involved in any TPSA committee, group, meeting, or voting. Affiliation records serve to assist with Conference planning, Membership assessment, BOD nominations, and overall Organization focus.
UNITED STATES ENVIRONEMTNAL PROTECTION AGENCY (U.S. EPA)
Individuals employed by the U.S. EPA.
GOVERNMENT AGENCY
Individuals employed by a local, province, state or federal agency (except the U.S. EPA).
PESTICIDE INDUSTRY
Entities or organizations that manufacture, formulate or distribute pesticides; manufacture or distribute pesticide containers; conduct pesticide research, education, training or consultation; manufacture, sell or distribute equipment and/or other products that are utilized in any aspect of pesticide manufacture, commerce, packaging, transport, application, use, and storage; and pesticide industry sponsored and funded organizations that undertake pesticide stewardship activities.
WASTE MANAGEMENT INDUSTRY
Entities or organizations that identify, package, or transport waste pesticides and residues, recycle waste pesticides and residues and/or pesticide equipment or containers or manufacture equipment to accomplish any of the above; and any waste-management industry sponsored and funded organizations that undertake pesticide stewardship activities.
PESTICIDE CONTAINER MANAGEMENT INDUSTRY

Organizations that are involved in any aspect of pesticide container management and any pesticide container management industry sponsored and funded organizations that are involved with pesticide stewardship activities.

INSTITUTIONS
Entities that are involved with research, teaching or extension in an area or areas of pesticide stewardship.
END USERS

Individuals or businesses that use or apply pesticides and organizations, trade associations or commodity groups that represent end-users or applicators.

PUBLIC OR ENVIRONMENTAL HEALTH

Individuals and organizations that are involved with environmental and natural resource protection, recycling, pollution prevention or other conservation or ecological issues and any other corporations that do not fit into any other category.

NON-AFFILIATED
Individuals and organizations that do not wish to identify with or do not fit into an area of affiliation listed above.
   
STEP 3. Payment

  Total


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