JLBA 2019 Membership Application
Welcome, we're excited to have you! Membership is from January 1 to December 31, annually. 2019 Dues are $65 if paid before Oct 1 2018, and $75 thereafter. Fill out the form below and use the PayPal button at jlba.org/become-a-member or mail a check to: JLBA, PO Box 19, Huntington, MA 01050
Type of membership: *
Business name: *
Your answer
Owner name(s): *
Your answer
Primary contact name: *
Your answer
Physical/street address: *
Your answer
Town: *
Your answer
Zip: *
Your answer
Mailing address (if different):
Your answer
Town:
Your answer
Zip:
Your answer
Phone 1: *
Your answer
Phone 2:
Your answer
FAX:
Your answer
Website:
Your answer
Email:
Your answer
Type of business:
Your answer
Business category (for map & directory):
For the annual Hilltown Destinations Map—Primary contact person:
Your answer
For the Map—Tag line (36 characters):
Your answer
For the Map—Public contact info to print:
Your answer
Would you like to make an additional donation to JLBA for promotions & outreach?
Any other info you'd like us to know about your business?
Your answer
Questions? Email JacobsLadderBA@gmail.com
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