Membership Application
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PENDLETON BUSINESS ASSOCIATION

Membership Application (Dues Payable January 1, 2007)

 $50.00 Annual Membership Fee

Print All Information Clearly

Information Provided Will Be Utilized for Publications and PBA E-Mails

 

Business Name: _______________________________________________________________________

Business Address: ____________________________  City: ________________  Zip: ______________

Business Phone: _________________________  Business Fax: ________________________________

Business E-mail: ________________________  Web Address: ________________________________

ADDITIONAL BROCHURE INFORMATION

Hours of Operation: (Limit 50 Characters) ________________________________________________

Business Description: (Limit 2 Lines of 50 Characters Each)

____________________________________________________________________________________

____________________________________________________________________________________

Do you have a Restroom the Public can use?  Yes or No

Is the Restroom Handicap Accessible?  Yes or No

 ** All information provided above will be used to compile the PBA Shop Pendleton Brochure.  

Add any comments below.

EMERGENCY INFORMATION NEEDED

 Owners Name, Address, E-mail and Emergency Phone:_____________________________________

_____________________________________________________________________________________

Contact Person, Phone  (if different than owner):  __________________________________________

Comments: __________________________________________________________________________

_____________________________________________________________________________________

Make checks payable to Pendleton Business Association c/o JoAnn Karaffa-Owens, Treasurer,  Pendleton Travel Company, 111 N. Pendleton Avenue, Pendleton, IN  46064,  Phone  765-778-2141