Step 1 – Application Form

STEP 1 -> Submit an application form:

Please review the PATCA Code of Ethics before proceeding.  You will be asked to agree to and to abide by this policy.  

Once your application and applicable fees have been received, please allow 2-3 business days for processing before you receive a login id and password to the website.

* indicates required

Membership Type: *
Affiliate - No references requiredMember - 3 professional references requiredCertified Professional Consultant (CPC) - 3 CLIENT references requiredCompany - 3 CLIENT references required

Your Name: *

How did you hear about PATCA? *

Your Email: *

Company:

Address: *

City, State, Zip: *

Country:

Work Phone:

HomePhone:

Cell Phone:

Website:

EDUCATION #1 College or University::

City/State #1:

Degree/Year #1:

EDUCATION #2 College or University::

City/State #2:

Degree/Year #2:

License/Certification #1:

Granting Organization #1:

Year Granted #1:

License/Certification #2:

Granting Organization #2:

Year Granted #2:

List any professional organizations you belong to:

List any Awards or Honors that you have received:

How many years have you consulted part time:

How many years have you consulted full time:

Are you a consultant now? *
No - not at presentYes - Part TimeYes - Full Time

Main Area or Field of Expertise:

If you are applying for grade of Member or CPC (not Affiliate), please list your references here so that we can follow up with them after they fill out the Reference forms in Step 3.

Reference 1 - Name, phone, email:

Reference 2 - Name, phone, email:

Reference 3 - Name, phone, email:

Any other comments or information:

Read the PATCA Code of Ethics here

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.*