Single (20.00) _____ Couple (30.00) _____ Lifetime Single (350.00) _____
Single (25.00) _____ Couple (40.00) _____ (Effective July 1, 2008)
New: ___ Renew: ___
Select the Chapter You Want to Join:
East Valley (Mesa) ___ Phoenix ___ Shadow Mountain (NE Phoeninx) ___
Flagstaff ___ Mohave (Bullhead City) ___ Tucson (Southern AZ) ___
High Country (Payson) ___ Yavapai (Prescott) ___
Business Membership
Application
Name: ______________________________________________
Address: ______________________________________________
City: ______________________________________________
State: ___________
Zip: ____________
Phone: __________________________
Registered Voter? (Y/N)___________
Email: _____________________________
Business Website Address: __________________________________
Referred By: _______________________________________
Select Your Membership Type:
Annual Business Member (125.00) ____
New: ____ Renew: ____ Business Card Received?
(Y/N)
Select the Chapter You Want
to Join:
East Valley (Mesa) ___ Phoenix ___ Shadow Mountain (NE Phoeninx) ___
Flagstaff ___ Mohave (Bullhead City) ___ Tucson (Southern AZ) ___
High Country (Payson) ___ Yavapai (Prescott) ___