Membership Application
Note: To Submit an application
your business must be within the following
 zip codes: 34450,34452,or 34453

Telephone 352-400-4639

www.invernessoldetowne.org

Yearly Membership $120.00
Prorated depending on the month of
membership acceptance by the Board.

Jan $110
Feb $100
Mar $90
Apr $80
May $70
Jun $60

July $50
Aug $40
Sept $30
Oct $20
Nov $10
Dec $120


SPONSOR NAME: _____________________________________________________
BUSINESS NAME: _____________________________________________________
BUSINESS OWNER: ____________________________________________________
CONTACT PERSON: ___________________________________________________
BUSINESS STREET ADDRESS: ___________________________________________
CITY: ___________________  STATE: ___________  ZIP: ___________________
MAILING ADDRESS: ___________________________________________________
BUSINESS PHONE: _________________ FAX: _____________________________
CELL PHONE: (    ) ___________________________________________________
EMAIL ADDRESS: ____________________________________________________
BUSINESS DAYS AND HOURS: __________________________________________
DATE OF APPLICATION: ____________  YEARS IN BUSINESS: _______
Committees/Areas I am interested in:
__
SPECIAL EVENTS    __ PUBLIC RELATIONS   __ MEMBERSHIP   __ OTHER

BUSINESS CATEGORY:
_____ Retail
_____ Business/Residential Services
_____ Dining/Night Life
_____ Health & Beauty
_____ Lodging/Hospitality
_____ Recreation/Activities
_____ Other (describe below)

____________________________

SHOPS - SPECIALTY:
_____ Antiques
_____ Apparel & Jewelry
_____ Art Galleries
_____ Food & Drink
_____ Gifts & Décor
_____ Variety Shop
_____ Other (describe below)

_____________________________

Please make checks payable to:

Inverness Olde Towne Association
Attention: Treasurer
P.O. Box 771
Inverness, FL 34451

IOTAMEMBERSHIPAPP011309