|
|
 |
|
|
|
Name
of shop
|
_____________________ |
|
Proprietor/Manager
|
_____________________ |
|
Address
|
_____________________ |
|
City/State/Zip
|
_____________________ |
|
Number
of Shops
|
_____________________ |
|
Telephone#
|
_____________________ |
| CHECK
THE FOLLOWING: |
| (
) |
Ice
Cream Shop |
(
) |
Supplier
or Servicer |
| (
) |
Ice
Cream & Sandwich Shop |
(
) |
Retail
or Food Store |
| (
) |
Soft
Serve Frozen Desert Shop |
|
|
| (
) |
Restaurant |
(
) |
Other____________ |
| DUES
SCHEDULE: |
|
Regular
Membership
|
$100
Annually, Payable June 1 |
|
Multiple
Shops
|
$5.00
add'l per shop |
|
Maximum
Fee
|
$150 |
|
Associate
Member
|
$175
Annually, Payable June 1 |
|
Fiscal Year June 1st to May 31st
(Members joining in the last quarter of the year will be fully
paid members until May 31st of the following year)
|
| |
| Check
Enclosed: $
_________ |
Date:___________ |
| Recommended
By: __________________________ |
|
|
 |
