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INCOMPLETE APPLICATIONS WILL NOT BE REVIEWED. Please identify yourself (Name): First name Middle Name Last name Sex Male Female Please provide the following contact information: Street address Address (cont.) City State   Select One Alabama Alaska Am. Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Other Zip/Postal code Home Phone Work Phone Cell Phone E-mail A brief introduction of yourself Your past affiliation with PPP either here in USA or in Pakistan Check All that apply I am interested to help organize local chapters of  PPP I am willing to volunteer my time for PPP activities I will contribute with write-ups for PPP web site I am willing to contribute financially for PPP I am willing to contribute my time for PPP newsletter  I am willing to contribute my time for lobbying for restoration of democracy By submitting this application I agree that I will abide by the constitution of PPP USA, and the decisions of Central Committee of PPP USA. I also understand that I do not become member automatically by submitting this application. My membership starts after getting a written conformation from Membership Committee PPP USA)