B&PG Midyear Membership – $10 or $5 Per Month Fields marked with an * are required Business or Individual * Business $10/month Individual $5/month How Many Months Are You Paying * Four Five Six Nine Seven Eight If you are joining in October–December or later, your full Business ($120) or Individual ($60) membership dues is good for the following year. Please use the Business Form or Individual Form for these applications. Business Name Contact Name * Address * City * US States * - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC Zip * Phone * Email * Website Address Facebook Page Divider Business Category Churches Education Financial/Banks Food/Restaurant Home Improvement Individuals/Residents Lodging/Accommodations Organizations Personal Services Professional Services Recreation Shopping/Retail Business Description Divider Check If Interested I'd like information about joining a committee. I am interested in sponsoring an upcoming member meeting or an evening mixer. Divider Application Type * New Membership Renewal Membership Acceptance * I understand that acceptance of my Membership Application is dependent on the B&PG receiving payment. I also understand that by becoming a member, I agree to receive periodic emails about our events and marketing programs. Payment * I will submit $10/month (Business) membership dues by check. I will submit $10/month (Business) membership dues through PayPal on the next page. I will submit $5/month (Individual) membership dues by check. I will submit $5/month (Individual) membership dues through PayPal on the next page. If you are a human seeing this field, please leave it empty.
