Long Island Advancement of Small Business - small business training, networking, seminars

Businesses with 50 employees or more please click here for more information about becoming an affiliate member of The Advancement of Small Business.

Checks or money orders can be mailed, along with your completed application to:

Long Island Advancement of Small Business
1 Hewitt Square # 217
East Northport, NY 11731

Application for Membership/Affiliate Membership

Please complete the following:

* Name of Principle/Owner:

* Title:

* Company:

* Address:

* City:

* State:

* Zip Code:

* Tel:

Fax:

Cell:

Number of full-time employees in business:

Check one:

Business-to-Business

Business-to-Consumer

Other

Person completing this form:

* Your Name:

* Telephone:

* Cell:

* Email:

Payment Information:

Card Type:

Name of cardholder (as it appears on card):

Card Number:

Expiration Date: (MM/YY)

CCV:
(see back of card):

Card’s Billing Address (if different than above):

Billing Address:

Billing City:

Billing State:

Billing Zip:

As an affiliate member, your credit card will be charged $395.00.

Long Island Advancement of Small Business | 1 Hewitt Square # 217 | East Northport, NY 11731