Poquoson Business Alliance

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Membership Application

Please complete as many of the items as you can. We are very happy to have you as a new member of the PBA.

After you complete the membership information, you will have a link that will allow you to pay your first annual dues online.

Again ... thanks for support the PBA !!!!!!!

First Name:

Last Name:

Home Phone:

Mobile Phone:

Street Address:

City:

State:

Zip Code:

Business Name:

Type of Business:

Position:

Business Phone:

Business Fax:

Email Address:

Business Street Address:

City:

State:

Zip Code:

Status:
Proprietor
Manager
Business Representative
Individual Member

Do you want to develop web pages for your business?:
Yes
No

Would you like to participate in group newspaper advertising?:
Yes
No

Would you like to give a presentation on your business at a PBA meeting?:
Yes
No

Do you have skills you are willing to volunteer to the PBA?:

Your skills are ....: