RHODE ISLAND MICROENTERPRISE ASSOCIATION
35 Belver Avenue - Suite 112 North Kingstown, RI 02852 Phone: 401-295-5537

Please PRINT and MAIL this form with your payment.

Association Membership Form - 2007

Today’s Date_____________________________________

Name______________________________________________________

Company___________________________________________________

Address_____________________________________________________

City_________________________ State____ Zip___________________

Phone_______________________________________________________

Fax_________________________________________________________

Cell Phone___________________________________________________

Web Site____________________________________________________

Type of Business_______________________________________________

Other Key Associates to be involved with improving your business: _____

____________________________________________________________

What can we do to help you make more money? ______________________

Please print and mail this form with your check for $95 payable to the Association at the address above.