Application for Membership
Space Coast Business Guild
Name: ______________________________________________________________
Business Name: ______________________________________________________
Business Phone: ______________________________________________________
Personal Phone: _______________________________________________________
Address: _____________________________________________________________
City: _____________________ State: _______ Zip: _______________
Email: _______________________________________________________________
Briefly describe your business below:
____________________________________________________________________
____________________________________________________________________
How did you find out about the Space Coast Business Guild?
Word of Mouth - Print Advertising - Internet - Other: ________________________
If from current member, who? ___________________________________________
Method of payment Cash Check Credit Card
SCBG Membership - $50 per year
Include an image
- $10 per year
Email your camera ready image (business card, logo,
headshot, etc.)
to
menna@cfl.rr.com. Dimension can be no larger
than 300 x 100 pixels at 72 dpi.
We reserve the right resize your image.
Name as it appears on card: ____________________________________________
Credit Card #: _______________________________________________
Expiration date: ________________ CCV # (3 digit code on back) ______________
Signature: _____________________________________
Please print and complete.
Mail to: P.O. Box 562773 Rockledge, FL 32956
Fax to: 321-635-6078
For information, please contact:
Jason
Rivera 321-591-1865
Email:
spacecoastguild@cfl.rr.com
Keep up to date on activities and interact with members.
To join
our Yahoo Group, visit
http://finance.groups.yahoo.com/group/spacecoastbusinessguild/
www.spacecoastbusinessguild.org
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