Member Number:

OR

First Name: Last Name:

First Name* Last Name* Title* Company* Address* Address 2 City* State/Province* Zip/Postal Code* Telephone* () Fax* () Email Address* Username* Password* (Passwords must be at least 6 characters long)

Membership Type*
Non-Profit Member	$295 (includes all luncheons)
**Non-Profit Associate	$125 (luncheons NOT included)
Allied Profession Member	$340 (includes all luncheons)
Allied Profession Associate	$150 (luncheons NOT included)

** If you are applying as a Sponsored Non-Profit Associate as defined by PGGNE by-laws and described on this web site, please indicate your sponsors name below:

(Required only for Sponsored Non-Profit Associates)

My institution category is (select one)*
Education	Medical
Private Sector	Other: Arts, Environmental, Religious, Social Services
My institution is paying for this membership

PGGNE Volunteer Opportunities

Communications: Compile email updates, website content updates, etc. Membership: Help to staff welcome desk at monthly programs, contact potential and/or lapsed members, welcome new members Programming: Suggest speakers, assist with set-up at monthly programs, and distribute handout materials Mentoring: Assist with recruiting mentors, help with coordinating mentor/mentee events

Mentoring Program
Would you like to serve as a mentor for a member of PGGNE in 2008-09	Yes	No
Would you like to be assigned a mentor from PGGNE in 2008-09?	Yes	No
Deadline for mentoring matches is September 26, 2008.

General Questions and Comments
Are you a member of another planned giving council?	Yes	No
Are you a member of NCPG?	Yes	No
Have you ever served on the board of another professional organization?	Yes	No
If so, which one(s)?
What topics would you like to see covered in the PGGNE newsletter?
Do you have recommendations for speakers or topics for PGGNE’s monthly meetings?
Please share any thoughts you have about PGGNE, including suggestions for programming topics and speakers, membership services, communications, the future of the organization, etc.
On-Line Signature and Form Submission

By placing a check in this box, I am signing that I fulfill the requirements of membership in one of the above categories as defined by PGGNE by-laws and described on this website.*

Please note: When you hit 'SUBMIT', you will be directed to our secure payment form. When you have completed the form, you will be directed to a confirmation page which will provide you a receipt of your membership application.