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2012 EWGA Albany/Capital Region Membership Directory Questionnaire
RequiredRequired Question(s)

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.

 
1.

Please enter the information indicated below.


First Name:
Last Name:
Job Title:
Company Name:
Email Address:
emailaddress@xyz.com

2.

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

 

50 characters left.
3.

Preferred Directory Listing Address:

Business
Home
4.

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

 

50 characters left.
5.

Preferred Directory Listing Phone:

Business
Home
Cell
Other  
6.

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

 

50 characters left.
7.

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

 

50 characters left.
8.

League:

 

50 characters left.

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.

 
9.

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

Yes
No
10.

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 

Yes
No
Required 11.

Confirmation:  This question is required to be answered.

Yes, please include the information I have provided in the 2012 EWGA Membership Directory.
No, I do not wish to be listed in the 2012 EWGA Membership Directory.