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

Businesses with 49 employees or less please click here for more information about becoming a member of The Long Island 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 a small business member, your credit card will be charged $195.00.

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