You have two options in how to submit your application. The first is to mail in the following pdf with a check or money order. The second is to fill out the online form below and pay using a credit card.
If you do cannot view the pdf below, please follow this link to download Adobe Reader.
Please fill out the application completely. You may clear all fields of the application by scrolling to the bottom and clicking "Clear form." The "Email application" button is non fuctioning at this time, so once you have completed the form please print it out and mail it to:
Regional Director of POWER!
Robert Watts
201 Lackawanna Avenue
Suite 211
Scranton, PA 18503
Please be sure to include your yearly
membership fee with your application.
Student - $15/Per Year
Individual - $25/Per Year
THE VALUES YOU PLACE INTO THE FORM CANNOT BE SAVED. Please print a copy if you wish to keep one for your records.
Application
POWER! Membership Signup Form
*=required
Membership Type:*
Email Address:*
Password:*
Re-type Password:*
Select Your Chapter:*
First Name:*
Last Name:*
Address:*
Address 2:
City:*
State:*
Zip Code:*
Phone #:*
Employer:*
Occupation:*
How did you hear about POWER!:*
Would you be willing to serve on a committee?*
Events Planning
Marketing/Communications
Membership
Not Interested
What types of activities would you like to undertake? (select all that apply)
