Palm Harbor Business OASIS

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REGISTER

NOTE: THIS FORM SERVES TWO PURPOSES:

TO JOIN: FOR PEOPLE WANTING TO BECOME MEMBERS OF THE PALM HARBOR BUSINESS OASIS.

FOR OASIS MEMBERS WHO WANT TO UPDATE THEIR PROFILES.

Membership in the OASIS is a smart business expense and costs as little as $50 per month. It can be purchased month-to-month, or for three months, six months, or an annual membership whereby you get one month free.

Required entries on this form are marked in RED. Please avoid using the pound symbol (#) as it may cause processing errors.

For questions, please contact Tim Bryce.

TYPE INPUT

TITLE Your FIRST NAME Your NICK NAME MIDDLE Your LAST NAME EXTENSION (Sr, Jr, II)

MAILING ADDRESS

CITY STATE ZIP/POSTAL CODE

COUNTRY

HOME TELEPHONE (include area code)

OFFICE TELEPHONE (include area code)

CELL PHONE (include area code)

E-MAIL

E-MAIL ALTERNATE

WEB ADDRESS (URL) - optional; http://www...

COMPANY

JOB TITLE

TYPE BUSINESS

COMMENTS

Press Send to transmit your request.

NOTE: By pressing SEND you are agreeing to be bound by the Terms of Membership.

Thank you for your Update!

TITLE	Your FIRST NAME	Your NICK NAME	MIDDLE	Your LAST NAME	EXTENSION (Sr, Jr, II)

MAILING ADDRESS

CITY	STATE	ZIP/POSTAL CODE

COUNTRY