Membership App.

American Sommelier Association

Central Pennsylvania Chapter

Membership App.

~ Membership Application ~

Please fill out form and click submit at the bottom of form. You will be notified when your membership has been activated.

(* Required Fields)

First Name *

Last Name *

Home Address *

City *

State *

Zip Code *

Telephone *

Mobile Phone

Fax

E-Mail *

Preferred Method of Communication *

Position at Employer

Name of Employer

Work Address

Work City

Work State

Work Zip

Work Phone

Work Email

Work Website

Membership Category *

ASA Membership costs $ 100 per year

Hospitality Industry:	Hotel and Restaurant; Private Club; Catering Company; Waitstaff and Management
Beverage Industry:	Retail, Wholesale, Importation, Wine/Culinary Journalism, Public Relations, Marketing, Production, Education, Communication, Design, Equipment Manufacturing, Viticulture and Wine Production
Student:	Currently enrolled as a Fulltime Student
Supporting:	Someone whose principle Business is other than a Beverage Career
Corporate:	20% Discount offered with a minimum of 5 members.

Other Notes

Payment Method *

On-line payments can be made by clicking the "BUY NOW" button.
For payments by check or money order, print the confirmation page, and send with check made payable to American Sommelier Association:		Mail to:
		Central Pennsylvania Chapter
		American Sommelier Association
		211 North Poplar Street
		Elizabethtown, PA 17022-2032

Revised: 03/03/2006

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