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Complete New Member Information Business Name: ________________________________________________________ Address: ______________________________________________________________ Web Site: ______________________________________________________________ E-mail: ________________________________________________________________ Phone: ________________________________________________________________ Contact Name: _________________________________________________________ Referred by: ___________________________________________________________
Membership Dues $100.00 Yearly
Print and return your completed form with
your payment, To: Newtown
Business Directory, 284
Sequoia Dr. Newtown, PA 18940
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