Chamber of Commerce of the Mastics and Shirley, Inc. organized and incorporated 1951 P.O. Box 4, Mastic, New York 11950 (631) 399 2228   "Working Together To Make It Better"

MEMBERSHIP APPLICATION

I HEREBY MAKE APPLICATION FOR MEMBERSHIP IN THE CHAMBER OF COMMERCE OF THE MASTICS & SHIRLEY, INC. AGREEING, IF ACCEPTED, TO ABIDE BY THE RULES AND REGULATIONS OF THE ORGANIZATION AS SET FORTH IN ITS CONSTITUTIONS AND BY-LAWS

DATE:                                                      

BUSINESS NAME:                                                                                 

DBA:                                            BUSINESS ADDRESS:                                                  

                                                      CITY:                              STATE:      ZIP:                         

BUSINESS TELEPHONE:                                                                   

NO. OF YEARS IN BUSINESS AT THIS LOCATION:                     

BUSINESS OWNER'S NAME:                                                       TITLE:                          

HOME ADDRESS:                                                 HOME TELEPHONE:                          

CITY:                            STATE:       ZIP:                       

(CHECK ALL THAT APPLY):             CORPORATION:            PARTNERSHIP:           

                                PROPRIETORSHIP:           FRANCHISE:            OTHER:          

NAME OF PERSON WHO WILL REPRESENT THIS BUSINESS AT CHAMBER MEETINGS:

            NAME:                                                     TITLE:

THIS APPLICATION FOR MEMBERSHIP IS SPONSORED BY THE FOLLOWING CHAMBER MEMBER:

            NAME:                                                     BUSINESS NAME:

A BUSINESS CHECK FOR $120.00 MUST ACCOMPANY THIS APPLICATION:

            APPLICANT'S SIGNATURE:                                                                

VOTED ON:              ACCEPTED:               TABLED: