Baldwin Chamber of Commerce 2015 Membership Please return this completed form with your check payable to: Baldwin Chamber of Commerce and mail to: Mahler Realty, 1030 Merrick Rd. Baldwin, NY 11510 Attn: BCC Membership Business Membership $125.00 Business Name _____________________________________________________________________________ Business Address ___________________________________________________________________________ City _______________________________________________ State ____________Zip __________________ Phone # _________________________Fax # ____________________ Cell Phone #______________________ Contact Name ______________________________________________________________________________ Email Address _____________________________________________________________________________ Website Address ___________________________________________________________________________ Business Category: _________________________________________________________________________ Fifty Words or less to describe your business for publication:_________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Resident Membership - $25.00 Name: Address: City: Phone:
State:
Zip: