APPLICANT INFORMATION
Mr.
Ms.
Dr. First Name
Last Name
MI
Title
Organization
Department
Company Address
City
State
Zip/Postal Code
Home Address
City
State
Zip/Postal Code
Home Phone
Business Phone
Fax
Email Address
Send all mail to my:
Home
Business
Email
PACKAGING RESPONSIBILITIES
Please indicate your primary packaging responsibilities and qualifications :
State briefly why you desire to become a member :
Years in the Packaging Industry
Membership Cagetory:
User
Supplier
Other*
Others
:
(if other please specify)
Professional Interest Areas:
Please list three areas of interest (with one as your primary) to help us target member benefits to your professional
interest (examples include Sales/Sales Management, Package Engineering, Machinery, Sustainability, Packaging Graphics)
1)
2)
3)
AGREEMENT
To the Board of Trustees:
I,
, Packaging Professional who has primary employment and/or residence in New Jersey,hereby apply to become a member of the New Jersey Packaging Executives Club.
(Signed)
Date
The following NJPEC Membership sponsors are familiar with my qualifications:
Name
Company
Name
Company
Please include a check for $80 for one year’s membership dues.
