New Membership – Distributor Member Application

Distributor Member

New CPDA Membership Application and Dues Calculation Form

Should you have any question please contact Carrie Haakana at chaakana@cpda.com – (202) 531-2232 or Terry Kippley at tkippley@cpda.com – (630) 544-9677

Company *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

PRIMARY CONTACT INFO:

Name *

First

Last

Title

Email *

Phone *

Invoicing Contact Name (if different)

Distributors - Distribution of pesticides and adjuvants (do not include micronutrients or fertilizer). CPDA dues are based on company net sales of these agricultural products (U.S. sales only). Information regarding Membership Dues is confidential and used only for the purpose of calculating membership dues. New Membership period is effective through year-end 2022.

Please check a category below that represents your company's most recent year-end U.S. net sales: *