WESO Membership Application

Today’s Date: Membership Year: Oct 1 to Sep 30

Last Name:	First Name:
Company Name:	Title:
Business/Mailing Address:
City:	State: Zip:
Business Phone:	Fax:
E-Mail:
Web Site:
How often do you check e-mail?
Home Address:	City: Zip:
Home Phone:
Include my business information on the WESO website (public area):
Business Description (approx. 40 word max.)

Years in Business:
How did you decide to join WESO? (Please check one below and explain.)
Current WESO member referred/encouraged me. Member's name:
Other. Explanation:

Type in your information, print the page, and mail with a check payable to:

WESO
P. O. Box 1662
Medford OR 97501

(NOTE: Your information is not sold or distributed outside the WESO membership without your permission.)

WESO USE ONLY
Amt Rec’d: ___ Entered in database ___ Entered in e-mail list ___ Website admin. notified ___