2003 - BUSINESS MEMBER

APPLICATION FOR ASSOCIATE MEMBERSHIP

Business Name:______________________________________________________________

Type of Business: _____________________________________________________________

Address: ___________________________________________________________________

Phone: _____________________________ Fax: ____________________________________

Email Address: ___________________________________________

Contact Person(s): ________________________________________

Please print this form, complete it and return it to our office with a check for $200.00.

Contributions or gifts to PSVOA/ASBO are not tax deductible as charitable contributions for federal income tax purposes. However, they may be deductible under other provisions of the Internal Revenue Code.