______________________

APPLICATION FOR MEMBERSHIP
PLEASE PRINT OR TYPE ALL INFORMATION

DATE________         

NAME OF BUSINESS_______________________________________

PHYSICAL ADDRESS OF BUSINESS____________________________________

MAILING ADDRESS OF BUSINESS_____________________________________

CITY_______________________________STATE________ZIP_____________

CONTACT PERSON_________________________________________________

EMAIL ADDRESS___________________________CHECK IF ALL LOWER CASE__

CELL PHONE#_________________BUSINESS PHONE#____________________

HOME PHONE#________________FAX#_______________________________

Information above will be placed on our web site at www.visitbigvalley.com  If you wish to withhold any of the above information, Please make a note of what you want withheld.

IN BRIEF, DESCRIBE TYPE OF BUSINESS________________________________ ________________________________________________________________

PLEASE ENCLOSE A CHECK IN THE AMOUNT OF $65.00  THIS IS A ONE TIME FEE.  MEMBERSHIP DUES WILL BE BILLED AT $50.00 PER YEAR OR AS DESIGNATED BY THE BOARD OF DIRECTORS.  DUES WILL START IN FEBRUARY AFTER YOU HAVE BEEN A MEMBER ONE FULL YEAR.

THE PRESENT COORDINATOR IS NANCY KAUFFMAN

HAVE QUESTIONS?  WRITE TO ABOVE ADDRESS

PHONE: 717-935-9965

EMAIL:  ank@pa.net                             www.visitbigvalley.com