EmailMe Form - PSCA Service Provider Membership

Primary Contact Information:

Name *

Prefix First MI Last

Firm *

Title: *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Work Number *

### - ### - ####

Cell Phone

### - ### - ####

Work Email Address: *

Alternate Email:

Secondary Contact Information:

Name

Prefix First MI Last Suffix

Title:

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

(if different from that of primary contact)

Work Number *

### - ### - ####

Email Address:

Plan Demographics:

1.What is the total number of U.S. employees at your company? *

2.What is your industry? *

3.What types of retirement plans does your company sponsor for employees? (Check all that apply) *

4.Do you offer:

3(21) advisory services

3(38) advisory services

Payment Information:

Dues are based on the total number of U.S. employees at your company. If you join Jan.-June you pay 100% of the annual rate, July-Oct. you pay 50%, Nov.-Dec. you pay 100% but includes mebmership for the following year.

Tier:
Tier 1: 1-100 employees
Tier 2: 101-500 employees
Tier 3: 501-1,000 employees
Tier 4: 1,001-10,000 employees
Tier 5: >10,000 employees
Tier 6: Law Firms (regardless of the number of employees)

Regular Rate:

July-Oct. Rate:

I am paying by: *

Check

Credit Card

Type of Credit Card:

Mastercard

Visa

Amex

Discover

Name as it appears on card *

First Last

Credit Card Payment *

Signature *

Clear

Paying by check? Please print a copy of your completed application and send with check payment to: PSCA, P.O. Box 34725, Alexandria, VA, 22334-0725.

Questions? Please call us at 703-516-9300.

Dues appearing on this application not valid after 12/31/2025.

Tax Deductions:
Dues, contributions or gifts to PSCA are not deductible as charitable contributions; they may be deductible, however, as ordinary and necessary business expenses. Federal law prohibits a tax deduction for the portion of membership dues attributable to lobbying expenses incurred by the organization. Consequently, for 2026, 18% of your dues are non-deductible in accordance with this provision.