Membership Form

ZCVB Membership Form

Member Information: All memberships renew on the first of June annually.

All Payments to be made: Megan Honer Orton, PO Box 630146, Rockville, Utah, 84763

Business Name:
Mailing Address:
City
Contact Person:
Email:
Local Phone:
Membership Fees:	$85 Base Membership Plus:
Full Time Employees $12/each	(full time employees work 1500 hrs per year or more)
Part Time Employees $7/each	(part time employees work 1500 hrs per year or more)
Additional Listing $45/each	(number of additional listings)
Associate Membership $35	(for supporters who do not have a business which benefits from membership. Base membership due not applicable)
	Total Due ($400 Max)
Business Contact Information
Business Name:
Location Address:
Mailing Address:
City
Web Address:
Business Email:
Zip:
Phone:
Fax:

Category

Business Information 25 words:

For any additional listings please fill out a second form.

Thank You.