Membership Application

Please print out this form and send, along with your check (and business card for us to scan if you'd like a website listing), to
      Northwest Business Club
        P.O. Box 31365
        Bellingham, WA  98228-3365
_______________________________________________________

I would like to apply for membership in the Northwest Business Club.
I understand that this is an individual membership.

            ___  Annual Dues $110
            ___  Semi-Annual Dues $55 (subject to review & approval)
          
Name _________________________________________________________________

Business ______________________________________________________________

Address _______________________________________________________________

City, State, Zip __________________________________________________________

Phone __________________________________     Cell _________________________

E-Mail ___________________________________________________________

Website __________________________________________________________