Penfield Business Association

Membership Application
Name of Member:
Name of Business:
Business Address:
Business Phone:
Business Fax:
Email Adress:
Website Address:

General Membership $75.00

This membership includes one postal mailing address for receiving PBA mailings and up to five individual e-mail addresses. This membership will have one vote. Please enter additional member names and email addresses (separated by a comma) on the right.

Member 1:
Member 2:
Member 3:
Member 4:

Premium Membership $175.00

This membership includes multiple individuals receiving PBA mailings at their individual postal addresses and up to ten individual e-mail addresses. This membership will have one vote. Please enter additional member names and email addresses (separated by a comma) on the right.

Member 1:
Member 2:
Member 3:
Member 4:
Member 5:
Member 6:
Member 7:
Member 8:
Member 9:

What topics would you like to hear about at future meetings?
Would you be interested in writing an article for the newsletter/web site?	Yes No
Would you be interested in serving on any of the following committees?
Membership Government Community Events Newsletter	Annual Business Directory Public Relations & Advertising Penfield in Bloom(gardens) Programs

Membership Application

WELCOME TO THE PENFIELD BUSINESS ASSOCIATION!

THANK YOU!