2006 MEMBERSHIP APPLICATION
(Information only – Invoices will be sent separately after 4/30/06)
Company Name:
_________________________________________________________
Contact Name:
___________________________________________________________
Mailing Address:
_________________________________________________________
City:
_______________________ State: ______________________ Zip:________
Email Address:
___________________ Website
or OTHER Info: ____________________
Would you be willing to serve as an officer? _____yes _______no ______maybe
Or help in another capacity? i.e._______________________________________________________________________
____________________________________________________________________________________________________________
Please complete and return to:
Address or fax listed above or email information to
jhthom@kimbanet.com
