Page 1

application form I would like to join WHYPG as an individual memI would like to join WHYPG as a companysponsored member (The membership stays with my company.) first name

last name

contact info address PO Box 1420 Winter Haven, FL 33882-1420

company

phone

mailing address

863-293-2138

city

state

zip

phone

fax 863-297-5818

e-mail date of birth Yes, please include my contact information in the WHYPG membership directory. I have a Facebook account.

email will@winterhavenchamber.com

website

METHOD OF PAYMENT:

cash check visa master Make check payable to the Winter Haven Chamber Foundation. credit card # The WHYPG is affiliated with

name on the card: expiration date:

V-code:

signature

date

2012 Membership Application

2012 WH Young Professionals Brochure  

Membership guide for the 2012 Winter Haven Young Professionals Group.