Business Membership Form
Join the Ephraim Historical Foundation today!
Today's Date
*
-
Month
-
Day
Year
Date
Membership
*
New
Renewal
Business, Service, Corporation, or Foundation Name
*
Owner(s) #1 First and Last Name
*
Owner(s) #2 First and Last Name
Would you like the business owner's name(s) listed in the membership book?
*
Yes
No
Check Box if Contact Information Has Changed
Contact Information Has Changed
Contact Person(s) #1 First and Last Name
Contact Person(s) #2 First and Last Name
Street Address:
*
Line 2 / P.O. Box#:
City:
*
State:
*
Zip:
*
Landline Phone #:
-
Area Code
Phone Number
Cell Phone #:
-
Area Code
Phone Number
Website
Email
myname@example.com
Do you want your email address listed in the Membership Booklet?
Yes
No
Is this your only address?
*
Yes
No
Winter or mailing address?
Winter
Mailing
Street Address #2:
Line 2 / P.O. Box#:
City:
State:
Zip:
Do you receive mail here?
Yes
No
From:
-
Month
-
Day
Year
Date
To:
-
Month
-
Day
Year
Date
If you are a new business member or a renewing business member and have updated your logo, please upload a .jpeg or .png file of your business logo, so that we can display it on our website and in the museum buildings. Preferably upload a logo that would work well on a white background.
Browse Files
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How would you like to receive your newsletters
*
E-mail (saves postage and printing)
Print (by mail)
Both
Please select a membership
*
Business Membership (listing for one business) $150
Multi-Business Membership (listings for two or more businesses) $200
Please enter membership amount (e.g. 500.00)
*
Would you like to donate to the Heritage Fund?
*
Yes
No
Please enter Heritage Fund donation amount (e.g. 500.00)
Total
Total
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USD
Total
Submit
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