Business Name: ________________________________________

Contact Name: ________________________________________

Title: ________________________________________

Mailing Address: ________________________________________

City/Zip: ________________________________________

Business Phone: ___________________

E-mail: ___________________

Website address (for linking purposes): ________________________________________

Yes__ No__ I am interested in serving on the Marketing Committee

Annual Dues
___$95 Business (2 or more locations)
___$65 Business (one location)
___$35 Associate Membership (Civic/Non-Profit/Individual)

Dues are for a calendar year. January-December

Please print out this form, make check payable to KPBA, and mail to:
PO Box 439, Vaughn, WA 98394
KPBA Contact Person: Dennis Taylor—884-7899

Key Peninsula Business Association