DPAAS Application

*Please complete this form, print and mail it along with your payment to:

DPAAS National
Attention: Ms. Kathryn Snyder
3100 Presidential Drive, Suite 300
Fairborn, OH 45324-6224

*Corporate members please complete and print a form for each individual, then send all the printed forms in one package, along with payment to the above address.  

Please select your membership below:
Dues (Check One): $35 - Government/Academic $60 - Industry Corporate/Organization
Dues information for Corporate/Organization Memberships:
  • $300.- Includes membership for up to 6 individuals from your organization
  • $400.- Includes membership for up to 8 individuals from your organization
  • $600.- Includes membership for up to 12 individuals from your organization
  • $800.- Includes membership for up to 16 individuals from your organization
  • $1,000.- Includes membership for up to 20 individuals from your organization
Personal Information
Mr., Ms., Rank...  
First Name & Middle Initial  
Last Name  
Company/Organization  
Street Address  
2nd Line Street Address  
City  
State/Province  
Zip/Postal Code  
Country  
Phone (Include Area Code)  
Fax (Include Area Code)  
E-mail  

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