Professional Associates Network (PAN) Membership
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Required Fields
Annual PAN Membership
Amount
$500 - Preservation Professional
$1,000 - Professional Friend
$5,000 - Professional Sponsor
$150 - Individual Practitioner
This is a
New Membership
Renewal Membership
Business Listing (as it should appear on PAN website)
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Business Name
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First Name
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Last Name
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Address
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City
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State/Province
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Zip/Postal Code
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Work Phone
Mobile Phone
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Email
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Website
Please list the business categories in which you should be listed.
Help Us Cover Costs
Simply leave "Yes!" checked below to ensure that 100% of your intended donation is available for our mission.
Yes! I want $500.00 to go to Preservation North Carolina and I will donate $510.00.
No. I will donate $500.00 and Preservation North Carolina will cover the processing costs.
Credit Card Information
Card Holder Name
Visa
MasterCard
Discover
American Express
Card Account Number
Expiration Date
01
02
03
04
05
06
07
08
09
10
11
12
24
25
26
27
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34
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Security Code
The 3 or 4 digit Security Code (CVV2) can be found on the back of your credit card.
For
American Express
, the Security Code (CID) can be found on the front of the card.
Close
Billing Address
Same As Above
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Address
City
State/Province
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Zip/Postal Code
Email
Privacy Policy
We keep your personal information private and secure. When you make a payment through our site, you provide your name, contact information, payment information, and additional information related to your transaction. We use this information to process your payment and to ensure your payment is correctly credited to your account.
Contact Us
: Preservation North Carolina •• P.O. Box 27644, Raleigh, NC 27611-7644 •• 919-832-3652 ••
[email protected]
•• www.presnc.org
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