New Member Application "*" indicates required fields X/TwitterThis field is for validation purposes and should be left unchanged.Use This Form for New Membership Applications Only. Is your company renewing its PCF Membership? If so, Do Not use this form. Instead, you must first be logged in. Then, use the Membership Renewal form link located within the Membership page top menu tab. This will prevent duplication of your company's PCF membership and interruption of its member benefits. * Note: All fields with an asterisk in their label are required fields.Company InformationThis field is hidden when viewing the formMembership IDHIDE when LIVE.This field is hidden when viewing the formCorporate TierHIDE when LIVE. Tier I - IV, See Membership Type field ID 49 and "Populate Membership Tier Field" WPCode SnippetThis field is hidden when viewing the formPCF Dues StatusCompany Name*Address*Address 2City*State/Province*Postal Code*Country*- Select One -United StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsThis field is hidden when viewing the formForm Submit Date HIDE when LIVE.This field is hidden when viewing the formMembership Expire Date UTCHIDE when LIVE. See "Membership Application - Convert to expire_at UTC Date" (1 year) - WPCode SnippetThis field is hidden when viewing the formMembership Expire Date DispHIDE when LIVE. See "Membership Application - Convert to Expire Display Date" (1 year) - WPCode Snippet. This field is hidden when viewing the formRand Co NumHIDE when LIVE. Random 5-digit numberThis field is hidden when viewing the formCo IDHIDE when LIVE. Combined Co Initial (2) [See WPCode] + Rand Num (5) MUST BE UNIQUEThis field is hidden when viewing the formCompany Admin Notes[08/03/2026 02:09 PM] New Membership registration. This field is hidden when viewing the formCompany Support Notes[08/03/2026 02:09 PM] New Membership registration. Primary Member InformationWill be listed as the company's primary contact and be responsible for membership renewal and adding and removing your company members.First Name*Last Name*This field is hidden when viewing the formDisp First NameHide when LIVE. Used to send Full Name to Stripe.This field is hidden when viewing the formDisp Last NameHide when LIVE. Used to send Full Name to Stripe.This field is hidden when viewing the formFull NameHide when LIVE. Used to send Full Name to Stripe.This field is hidden when viewing the formOrder DescriptionHide when LIVE. Used to send Order Description to Stripe.CredentialsJob Title*Are you the CCO or GC?* Yes No Primary Country- Select One -United StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsEmail* Enter Email Confirm Email PhonePhone Type* Mobile Office Other Password* Enter Password Confirm Password Strength indicator The PCF website requires strong passwords, which should be at least 12 non-repeating characters in length and can contain upper and lower case letters, numbers, and special characters.This field is hidden when viewing the formHIDE when LIVE. Rand Username NumRandom 6-digit numberThis field is hidden when viewing the formUsernameHIDE Username when LIVE (Last 2 + First 1 Initials [See WPCode] + Rand Num)This field is hidden when viewing the formPrimary Member Yes HIDE when LIVE. Default checked (Yes) for New & Renewal form. Use for Member Profile reports only.This field is hidden when viewing the formOpt Out of Member Directory Include me in the Member Directory Remove me from the Member Directory This field is hidden when viewing the formMember Admin Notes[08/03/2026 02:09 PM] New Membership registration. This field is hidden when viewing the formMember Support Notes[08/03/2026 02:09 PM] New Membership registration. Membership InformationMembership Type*Based on total number of US employees. Tier I - Up to 250 employees - $1,150.00 Tier II - 251 to 1,000 employees - $2,300.00 Tier III - 1,001 to 3,000 employees - $3,450.00 Tier IV - Greater than 3,000 employees - $4,600.00 I have a first-year discountDo you have a first-year discount? Yes New Member Discount* Enter your New Member Discount code above and click the Apply button. TotalTotal This field is hidden when viewing the formTotal Order - NumberHIDE when LIVE. Value from Total. Add to default value in ID88This field is hidden when viewing the formOrder Total - TextHIDE when LIVE. See Advanced => Default value.Payment InformationPayment Method* Credit Card Check ACH This field is hidden when viewing the formMembership Status - CC - ManualHIDE when LIVE. Maybe this field can be deleted?This field is hidden when viewing the formMembership Status - Check - ACHHIDE when LIVE. Maybe this field can be deleted?This field is hidden when viewing the formMembership StatusHIDE when LIVE. Credit Card or Manual Maybe this field can be deleted?Credit Card Make check payable to: Pharmaceutical Compliance Forum Mail payment to: Pharmaceutical Compliance Forumc/o Debra Scanlon 500 W. Palm Dr. Myrtle Beach, SC 29579 Please contact Deb Scanlon, PCF Administrator for bank information at deb_admin@pcf-org.com.
