| James House Association, Inc. |
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| PO Box 234 |
| Hampton, NH 03843-0234 |
| BUSINESS MEMBERSHIP/DONATION FORM |
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Name of Firm's Responsible Contact________________________________________ |
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Firm's Name________________________________________ Date______________ |
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Address________________________________________ Email______________________ |
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City, State, Zip___________________________________ Phone__________________ |
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ANNUAL MEMBERSHIP CATEGORIES |
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| ___Associate | $ 100 - 199.99 | |||
| ___Friend | $ 200 - 999.99 | |||
| ___Benefactor | $ 1000 - 4,999.99 | |||
| ___Sponsor | $ 5000 and above | |||
| TOTAL MEMBERSHIP AMOUNT | $_________ |
| DONATION | $_________ |
| TOTAL AMOUNT ENCLOSED | $_________ |
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Make checks payable to the James House Association, Inc. and mail to the address above. James House Association is a non-profit organization tax exempt under IRC Sec 501(c)(3). Membership dues and donations are tax deductible to the full extent provided by law. |
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All donors will be listed in the newsletter unless you wish to be anonymous. My firm wishes to be anonymous ______. |