GSDBA 2009 Business Resource Directory - (Page 257) 257 GSDBA Membership Application First Name: Last Name: Business Name: Business Category: Business Address Street: Suite/Unit: City: State: Zip: Mailing Address (if different from Business Address) Street: Suite/Unit: City: State: Zip: Primary Phone: ( ) Fax: ( ) Email Address: Website: I am applying for membership with the GSDBA as a: q General Member q Non-Profit Organization 501(c) 3 # ] q Student/Retiree $195.00 $100.00 $ 75.00 I would like my GSDBA Membership Certificate to display: q My Name or q Business Name q q q I authorize the GSDBA to publish my name, photo, and or business address in the GSDBA Newsletter. I authorize the GSDBA to send me membership updates and information via email. I authorize the GSDBA to include my name on a confidential mailing list for GSDBA members to advertise services and community events. q Print Ad q Website q Television q The Directory q Current Member (name): I heard about the GSDBA through: Method of Payment q Check or Money Order q Visa q Master Card q American Express Credit Card #: 3 Digit Code (on back of Credit Card): Expiration Date: / Name as it appears on Credit Card: Signature: Date: Referred by: Please detach and mail to: GSDBA, P.O. Box 33848, San Diego, CA 92163-3848 Membership Application also available online at www.gsdba.org All information submitted is considered confidential and is for GSDBA use only. Prices subject to change; call 619-296-4543 http://www.gsdba.org
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