Enrollment Form
As a business owner, you have a lot on your mind. There's a constant tension between advertising, gaining new clients, and keeping costs down.

Meanwhile, we at Mount Airy Bible Church have an ever-evolving church family. Some have attended for years, while others are brand new to the Mount Airy area. And Murphy's law tells us that someone is always going to be in need of a plumber, builder, or lawyer.

So let's cut to the chase — here's our sales pitch:

We want to highlight your business in our next business directory. We're collecting business names until May 31, and we'll have a completed version by mid-June. Then we'll send it out to our church family and ask them to consider using your business.

This could be a win-win situation. You get connected with more potential customers, and they see your business as one they can trust.

Are you in?

If so, all we need you to do then is to fill out the form below. If you want, you could offer a special for our MABC family, but it's not required in order to participate.

We just want it to be easy. Easy for you, and easy for our people.

Your Name (First & Last) *
Your answer
Your Relationship to Mount Airy Bible Church *
Your Business' Name *
Your answer
Your Business' Phone Number *
Your answer
Your Business' Website *
or N/A
Your answer
Your Business' Email Address *
or N/A
Your answer
Your Business' Category *
e.g., plumbing, car sales, construction — List as many as apply.
Your answer
OPTIONAL: Special Promotion for the MABC Church Family
Your answer
Disclaimer & Agreement *
In submitting this form, I freely, knowingly, and voluntarily acknowledge (1) that I am the owner or have a controlling interest in the business represented above, (2) that I have the authority, whether by ownership interest, operating agreement, etc., to submit, authenticate and/or authorize the business information for distribution, (3) that no other individual has the authority, whether by ownership interest, operating agreement, etc., to grant permission for the submission, authentication and/or distribution of the business information to be distributed, (4) that I am giving Mount Airy Bible Church (MABC) and its leadership permission to distribute my business information through printed and/or electronic means to the church family, (5) that MABC shall be distributing my business information solely as a convenience to MABC’s church family, (6) that if at any time I decide that I no longer want to be listed in this particular business directory, whether print or electronic, I shall notify MABC in writing, (7) that my business information shall be distributed “as is”, without any type of warranty by MABC, whether implied or otherwise, (8) that all of my business information being distributed was provided solely by me, (9) that said distribution of my business information to the MABC church family does not and shall not imply MABC’s endorsement, approval, and/or recommendation of any of my business content, opinion, product, and/or service, (9) that MABC makes no promises about the completeness, accuracy, condition, and/or reliability of my business information being distributed, (10) that MABC makes no promises about the completeness, accuracy, condition, and/or reliability of any person(s) and/or entity(ies) that enter into any business relationship with me and/or my business that has been developed and/or initiated by my business information being distributed to the MABC church family, and (11) that I absolutely and unconditionally release MABC from any and all rights, causes of action, claims and/or obligations arising out of any and all business relationships developed and/or initiated by my business information being distributed by MABC.
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