West Washtenaw Business Association, Join Us

Member Application

Please fill out the form below to join the WWBA or to renew your membership. Once we receive your membership dues we will send you your user name and password by e-mail so that you can access the For Members Only section of the web site.

Date: February 6, 2012
Type of Application: Join Renewal
Type of Membership: Regular ($75/year) Enhanced ($110/year)
Organization or
Company Name:
Company Location Address:
Company Mailing Address:
City, Zip Code:
Representative(s) to WWBA:
Phone Number:
Fax Number:
E-mail Address:
NOTE: An e-mail address is not required, but to use some of the features of our website, you will have to supply one.
Website:
Directory Information
(Services/Products Offered):
Submitted by & Title:
Would you like to serve on the Board? Yes No
Would you like to
serve as an officer? 		Yes No
Would you like to
serve on a committee? 		Yes No
Would you like to
receive notices/announcements
regarding local issues via email? 		Yes No
Please type the characters you see in the image below into the box next to the image.
   
Who referred you
to the WWBA?
   
Payment Options:


Mail payment to P.O. Box 2801, Ann Arbor, MI 48106-2801