Membership Registration FormNotification E-mail address must be company or agency affiliated. No personal E-mail addresses.Please complete the form below, no partial applications accepted.
Notification E-mail Address* Confirm Notification E-mail Address Daytime Phone* (include area code) Mobile Phone (if available) (include area code) Mobile ProviderSelect your mobile provider...AT&T WirelessCingular WirelessNextelSprint PCSSuncomT-MobileUS CellularVerizon WirelessVirgin MobileAlltelCell 2000Midwest CellularMTS CanadianQwestRural Cellular CorporationUnicell Can receive text messagesMobile Email Address 24 hr Emergency Number (if available)(include area code)Access Members Only AreaCreate password to enter members only area*
(e.g. Second largest petrochemical facility with refining capacity of xxx barrels per day)
(list items or services below)
SIC Code (click here to find your SIC Code)
Do you grant permission for the City to list your business as a member of PER on the website,in written materials or other public documents?* Yes No
Providing false or misleading information is a violation of Federal Law and may besubject to prosecution under Title 18 USC 1001.
All information is subject to review and verification.Completion of this application is no guarantee of inclusion in PER.