If you would like to become a part of the Cincinnatus Business Association, Inc., please print and complete the membership application below.  Return the completed application, along with your annual membership dues of $40.00, to P.O. Box 299, Cincinnatus, NY 13040.

                                                      Membership Application



Date:____________________________________________________________

Firm or Individual's Name:____________________________________________

Contact Person:____________________________________________________

Type of Business:___________________________________________________

Address:__________________________________________________________

City:______________________________  State:____________  Zip:_________

Telephone Number:_________________________________________________

E-Mail Address:____________________________________________________

Website URL:______________________________________________________

I would be interested in serving on the Board of Directors:  _____ Yes      _____ No

*The preferred way of sending communications from the association is via e-mail.



_____________________________________     __________________________
                         Authorized Signature                                                                Title


                            Please return completed application and membership dues to:

                                            Cincinnatus Business Association, Inc.
                                                                    P.O. Box 299
                                                        Cincinnatus, NY 13040