Membership Application

Information	for Publication	Information	for Billing
Organization Name		Name
Contact Name		Billing Address
Business Address		Billing City State Zip
Business City State Zip		Billing Phone
Business Phone		Billing FAX
Business FAX		Billing Cell
email			Type of Business
Basic Membership	Investment
	Admin Fee(New Members) $50	I am interested in:	check all that apply
	Home Based/Non-Profit/Individual $250		Co-op Promotional Activites
	Small Business $375		Special Publications
	Corporation $800		Area Map
	Special District $800		Member to Member Discount
	Gaming $1,200		Bulk Mailing
			Event Sponsorship
			Trade Shows
			Retail Terminal
			Area Directory
			Networking Events
			Street Banners
			Web Advertising
			Web Links
			Customer Satisfaction Program