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MEMBERSHIP APPLICATION
Full Name:
Title:
Company Name:
City/State/Zip:
Business Address:
Fax Number:
Phone Number:
Website Address:
Email Address:
Year Established:
Business Ownership:
Existing business
Start-up business
Non-owner
Status of Business:
Sole Proprietor
Partnership
S-Corporation
Corporation
Indicate Membership:
Status:
New Member
Renewal
which committee would you like to join:
Communications
Community outreach
Fundraising
Gala
Grant
Government Affairs
Membership
Programs/Special Events
Special Projects
How did you hear about WBO-PGC ?
Member referral
Website
PGC Gov't Agency
Other
Dues
Individual ($125)
Associate ($200)
Corporate ($500)
Link from WBO website
URL:
Logo Available:
Yes
No
Information will be used in WPO-PGC Membership Directory?
Yes
No
Please write a 25 word or less summary of your business add/or services offered:
(Information will be used in WPO-PGC Membership Directory
What are some of the things you would like to see at wbo?
Applicant Signature:
Date:
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