Membership Application

  1. Welcome to PATCA! We're delighted that you've chosen to join the premier organization for independent consultants. As the oldest national association of its kind, PATCA helped define ethical standards for the consulting industry. Now, as a member of PATCA, you will have unique opportunities to connect with prospective clients and other experienced professionals who consult at the expert edge.

    I hereby apply for membership in PATCA. I subscribe to the purposes of the association and agree to abide by the Code of Ethics and standards established for members. I attest to the accuracy of the information provided in this application and grant permission to PATCA and its representatives to investigate as may be necessary to establish my qualifications.

    The Application Fee in the amount of $75.00 ($35.00 for Affiliate application) will immediately be charged to your credit card. Application fee will be credited to annual dues upon approval of Membership Application. If you are mailing this form with a check, please make it payable to PATCA and remit to: P.O. Box 2261 Santa Clara, CA 95055.

    PATCA is offering a 25% discount to the fees below for new memberships. The discount will be applied by PATCA Office after application approval.

  2. APPLICATION GRADE (rates effective December 1, 2010)
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  4. Member Information - Please use a separate form for each applicant
  5. Name(*)
    Please let us know your name.
  6. Title
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  7. Company
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  12. Work Phone
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  13. Home Phone
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  14. Web Site URL
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  15. Email Address(*)
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  16. PATCA Sponsor
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  17. Education (1)
  18. College or University (1)
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  45. Awards and Honors
  46. Award/Honor (1)
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  48. How many years have you been a consultant?
  49. Full-Time
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  51. Are you now a consultant?
  52. Full-Time
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  54. Main Area or Field of Expertise
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  56. References

  57. All applicants (except for Affiliate members) must supply letters of reference as follows:

    REFERENCES
    Full Member: 3 references from current or former clients
    Associate Member: 3 references from clients or professional colleagues
    Company Member: 6 references from current or former clients
    Associate Company Member: 6 references from clients or professional colleagues

    A Reference Letter template is available from the PATCA office upon request. Your references may also use this online form in lieu of drafting a separate letter, to save time.

  58. Reference (1)
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  88. The Application Fee in the amount of $75.00 ($35.00 for Affiliate application) will immediately be charged to your credit card. The application fee will be credited to annual dues upon approval of Membership Application. If you prefer, you can also complete this form on your computer, and use the PRINT command on your browser to PRINT it. Then mail to: PATCA, P.O. Box 2261 Santa Clara, CA 95055 USA Or, fax it to: (866) 746-1053.

    Questions on application? Call (800) 747-2822 Email admin@patca.org.

    If you are making payment with a check, please make it payable to PATCA. An incomplete form may delay the processing of your application. Don't forget to refer your references to the online Reference Letter to expedite your application.

  89. Click on Submit to Send Application Form Information via Encrypted Secure Server
  90. Name of the Person Submitting this Form
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  91. Enter the characters exactly as shown.
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  92.   

  93. If you are mailing this form, a written signature is required. If you are sending this form via the SUBMIT button, your Electronic Signature will suffice.

    Written Signature: _______________________________________________________