Membership Registration Form

Membership Registration Form

Millstone Business Alliance
Member Name

First NameLast Name
Preferred Email
example@example.com
Preferred Phone
Please enter a valid phone number.
Attendees
Company Name
Experience in Profession
Years of Experience
Website and Social Media
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What are you most interested in by becoming a member of Millstone Business Alliance? (Select all that Apply)

New Clients/CustomersProfessional DevelopmentPersonal GrowthJob OpportunitiesIndustry ExpansionOther
Payment Details

Payment Amount*

USD$50.00 before July 1st 2025- $100 after July 1st

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Reminders
- Invite a friend! We encourage our Members to bring a friend. All guests must check in and must be open to communication from Millstone Business Alliance.
- Payment - All Payments received before July 1st will be $50 for your annual membership. Memberships paid after the 1st of July will be $100 for the year.
- Payment Method - Check
- Checks made Payable to: Millstone Business Alliance
- PO BOX 183 Clarksburg, NJ 08510
Criteria for Millstone Business Alliance Membership

To become a member you must meet one or more of the following:
- Own a business located in Millstone and be a resident of Millstone.

-Own a business located in Millstone, but reside outside of Millstone.

-Be a resident of Millstone and own a business located outside of town.

-Be a local farmer operating in or servicing the Millstone Community.
Do you meet the above requirements for Membership?
Signature

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Attendees