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Name

Business Name:
Contact Person:
Title:
   

Contact Information

Address:
City:
State:
Zip:
Phone:
Fax:
Email:
Website:
   

Additional Information

Base Fee:
(FTE - Full Time Employees or Equivalent)
Number of rooms: (Lodging Only)
Number of campsites: (Campgrounds Only)
Number of chairs: (Restaurants/Bars Only)
Number of stores: (Malls Only)
Total Dues:
Total Dues = Base Fee Plus Dues Per Room/Site/Chair/Store
Comments: