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Application for Allied Business Membership

 
Please fill out and print this form and either mail or FAX to:

Minnesota Licensed Beverage Association
St. Paul Business Center East
1983 Sloan Place • Suite 6
St. Paul, MN 55117
FAX: 651-772-0900

 

Application is hereby made for allied membership in the Minnesota Licensed Beverage Association. The financial investment is $399.00

$ For unit(s)


Company:

Contact:

Address:

City:

State:

Zip:

Phone:

Fax:

Product / Service:


Payment Method:

Visa; - M/C; - Discover;
Check Enclosed

Name on Card:

Address/Zip on Card

Card Number:

Security Code :

Expiration Date:


Your financial investment in the Minnesota Licensed Beverage Association is neither a gift nor a contribution. It is a tax deductible business expense and must accompany this application. Your membership investment is subject to review by the Association's Membership Committee and to final approval by the Association's Board of Directors.


Proposed By:

Date:

Signature: