Discover Historic Buffalo
Application for Membership

Annual dues are $100.00
 

Name:  _________________________  Position: ______________________

Business Name:   ________________________________________________

Services Provided:  ______________________________________________

Business Address:  ______________________________________________

City:  ___________________  State:  ______  Zip Code:   ________________

Telephone:  _______________  800 or Mobile Telephone:  ________________

E-Mail Address:  ___________________  Website:  _____________________
 

Choose up to 2 categories from those listed to describe your business:
checkbox.gif (91 bytes)   Accommodations checkbox.gif (91 bytes)  Antiques checkbox.gif (91 bytes)  Appliance/Electronics
checkbox.gif (91 bytes)  Art Galleries checkbox.gif (91 bytes)  Auto Repair/Detailing checkbox.gif (91 bytes)  Banks/ATM Locations
checkbox.gif (91 bytes)  Bath/Boutique checkbox.gif (91 bytes)  Bakery/Grocery Stores checkbox.gif (91 bytes)  Banks
checkbox.gif (91 bytes)  Bath checkbox.gif (91 bytes)  Books checkbox.gif (91 bytes)  Car Wash
checkbox.gif (91 bytes)   Campgrounds/Mobile
          Home Parks		 checkbox.gif (91 bytes)  Car Rental checkbox.gif (91 bytes)  Chiropractor
checkbox.gif (91 bytes)   Clothing/Accessories checkbox.gif (91 bytes)  Community Center checkbox.gif (91 bytes)  Dining
checkbox.gif (91 bytes)   Espresso/Coffee checkbox.gif (91 bytes)  Ice Cream Parlor checkbox.gif (91 bytes)  Gift & Specialty Shops
checkbox.gif (91 bytes)   Golf checkbox.gif (91 bytes)  Grocery/Bakery checkbox.gif (91 bytes)  Guest Ranch
checkbox.gif (91 bytes)   Hardware checkbox.gif (91 bytes)  Information checkbox.gif (91 bytes)  Internet/Paging
checkbox.gif (91 bytes)   Media/Radio checkbox.gif (91 bytes)  Museums checkbox.gif (91 bytes)  Needle Art/Stitchery
checkbox.gif (91 bytes)   Prescriptions checkbox.gif (91 bytes)  Printing/Office Supplies checkbox.gif (91 bytes)  Real Estate
checkbox.gif (91 bytes)   Sporting Goods checkbox.gif (91 bytes)  Truck Stop/Gas checkbox.gif (91 bytes)  Video Rental
checkbox.gif (91 bytes)  Web Design checkbox.gif (91 bytes)  Other  
Check One:

______ Check or Money Order enclosed for $100.00

______  Please bill me

Mail Membership Application to:

Discover Historic Buffalo
P.O. Box 383
Buffalo, WY  82834

or deliver the form and your membership fee to the Buffalo Chamber of Commerce.

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