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
contact info address PO Box 1420 Winter Haven, FL 33882-1420
e-mail date of birth Yes, please include my contact information in the WHYPG membership directory. I have a Facebook account.
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:
2012 Membership Application