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#GRAY-NEW GLOUCESTER BUSINESS ASSOCIATION Membership Application Name of Business/Individual: _______________________________________________ Mailing Address: _________________________________________________________ Location Address: ________________________________________________________ Business telephone: ____________________ Business Fax: _______________________ E-mail: ______________________________ Other: _____________________________ 1st Principal: __________________________2nd Principal: ________________________ Home Phone: _________________________ Home Phone: _______________________ Type of Entity (check one): Corporation _______________ S-Corp_____________ Sole Proprietorship_________ Partnership _______________ Non-Profit___________ Individual ______________ Number of employees (including owners, partners, corporate officers, etc.): ___________ Brief description of business (if applicable):
Please note: All business members' company name, phone and fax numbers and e-mail address are automatically listed on the G-NG BA web site (www.gbamaine.org). If you do not wish to be listed, please check here. ________________ On our website and for other purposes our members are assigned to one of the following categories. Please check off the appropriate category for your business: Accommodations ________ Banquet Facilities_______ Business Services_____________ Construction Trades Dental Care ____ Education ___ Insurance________ Environmental Family Fun/Fitness_ Financial Forestry/Lumber________ Funeral Homes_________ Health Care ______ Heating Oil__ Insurance Landscaping _ Legal Service Manufacturing_________ Medical Equip. ___ Misc. Services__ Organizations Painting __ Publications Real Estate___________ Restaurants __________ Retail__ Annual Dues: $50 (individual to 15 employees); $100 (over 15 employees). Please make checks payable to Gray-New Gloucester Business Association, PO Box 843, Gray, ME 04039 The purpose of this Association is to attract, enhance, and promote the environment of the business community. Membership in this organization shall be open to all businesses, entities and individuals interested in the commercial, industrial, agricultural and civic progress of the greater Gray-New Gloucester area. For G NG BA Use Only: Date of____Accepted_________________Sponsor_____________________$Recd____________________ Rev. Jan 2006 |
