MPBA Membership Application

If you would like to join, complete and print the application. Mail with your check (or cc info) to: MPBA P.O. Box 1635 Mount Pleasant, SC 29465. We also accept VISA, MST & AMEX!

Membership Type:

Company Information
Company Name
Company Mailing Address
City
State
Zip
Company Phone
Company Fax
Company Website
Brief description of business:
Contact Person
First Name
Last Name
Phone
Fax
Email

Committees
I would like to participate on the following committees:
Meeting programs	Educational/Charity
Media/Marketing	Member development
Note: If sending to printer via unsecured wireless network - print and then fill in cc info by hand before mailing.
Card Number: Exp Date: / 3 Digit Security Code (last 3 on back of card): Amount to charge: (Signature:___________________________________________