We would like your input on what and how much information you would like published in the 2012 EWGA Albany/Capital Region Chapter Membership Directory.  You may fill in as many or as few of the fields as you like. 

If you do NOT want to be listed in the 2012 EWGA Membership Directory at all, please check "No" in the box at the bottom of this form. 

If we do not hear from you, we will display your “NAME” and “EWGA MEMBER SINCE” in the 2012 directory. 

All information must be submitted by April 30, 2012.  The completed directory will be mailed to all members in June.

Please enter the information indicated below.

Preferred Directory Listing Address:
(Address, City, State and Zip)

Preferred Directory Listing Address:

Preferred Directory Listing Phone:
(XXX-XXX-XXXX)

Preferred Directory Listing Phone:

Business Category:
(I.e. Legal, Real Estate, Insurance, Non-Profit, Government, etc.)

EWGA Member Since:
(If you are not sure, just write "not sure"  We will list the year joined from Association Headquarters.)

League:

The following two questions pertain to the Business Index Section of the directory and are optional. 

Please contact albanyewga@gmail.com should you have any questions regarding the Business Index Section.

I would like my business listed in the Business Index Section of the directory.  There is no charge for this listing.

I would like to place an ad in the directory.  Ads are business card size (2X3.5) in black and white.  There is a $40 charge for this ad. 

Please send payment to EWGA Albany/Capital Region Chapter, P.O. Box 208, Latham, NY 12210.  The ad should be in a jpg or pdf and emailed to AlbanyEWGA@gmail.com 

Confirmation:  This question is required to be answered.