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MidStates 2011 Application

MidStates 2011 Application

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Published by mangnall

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Published by: mangnall on Jan 31, 2011
Copyright:Attribution Non-commercial

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01/31/2011

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C
OMPANY 
I
NFORMATION
 
Company Address (Please provide a street address)City State Zip CodeCompany Phone Company FaxToll Free Toll Free FaxCompany E-mail Company Website
C
ONTACT
I
NFORMATION
 
NEW MEMBER APPLICATIONJANUARY 2011 - DECEMBER 2011
16020 Swingley Ridge Rd., Suite 300Chesterfield, MO 63017Phone: (636) 449-5075 Fax: (636) 449-5051
 
www.midstateshpba.org
M
EMBERSHIP
B
ENEFITS
 
 All non-manufacturing members located in theU.S. and Canada join the affiliate organizationwithin their geographic area and gain Hearth,Patio & Barbecue Association membership atno additional cost. Benefits include:Complimentary EXPO PassesBusiness Insurance ProgramsCost Saving Affinity Programs Annual Membership DirectoryEducational and Resource Materials And much more!
 
For additional benefits visit www.midstateshpba.org 
M
EMBERSHIP
C
 ATEGORIES
 
 _
Retailer $200
(5 Complimentary EXPO Passes) 
 
 _
Distributor $705
(8 Complimentary EXPO Passes) 
 
 _
Manufacturers’ Representative $395
(4 Complimentary EXPO Passes) 
 
 _
Service $200
(3 Complimentary EXPO Passes) 
 
 _
 Associate $705
(6 Complimentary EXPO Passes) 
 
 _
Non-Profit $190
(3 Complimentary EXPO Passes) 
 
 
Primary Contact___________________________________ Title____________________________________________ Email___________________________________________ Phone___________________Fax____________________ 
Total Amount: $_______________________ Please charge my credit card:
 __
MasterCard
 __
 VisaCredit Card Number:_______________________________ Expiration Date:___________________________________ Signature:_______________________________________ 
 __________
Enclosed is my check 
 please make checks payable to MSHPBA 
P
 AYMENT
I
NFORMATION
 
Office Use Only:

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