Membership Application Form

Business/Organization/Individual:   ______________________________________________________

Contact Person/Title:  ________________________________________________________________

Location Address:   __________________________________________________________________

City/ZIP Code:   ____________________________________________________________________

Mailing Address:  ____________________________________________________________________

City/ZIP Code:   _____________________________________________________________________

Business Phone:   ____________________  FAX Number:   __________________________________

Website Address: _____________________________________________________________________

E-mail Address:  ______________________________________________________________________

Signature:  ______________________________   Date:   ____________________________________

Make check payable to Route 206 Scenic Byway Association

I am enclosing my annual membership fee:        ____   $15.00

I am contributing an additional  ____________  (please specify amount) for the General Fund to help defray administrative and advertising costs.

Please contact me regarding:   ____  Route 206 Guide Advertising

Route 206 Scenic Byway Association, Inc.  R.D.#2, Box 23, Walton NY 13856   www.route206.org