NABA MEMBERSHIP APPLICATION
BUSINESS
PROFILE
Company
Name________________________________________________________________________
Company
Address______________________________________________________________________
City________________State/Province________________Country_____________ZipCode____________
Legal Structure:_____Corporation_____Sole Propietorship_______Partnership______LLC_____Other_______
Telephone_______________Fax_________________Pager__________________Cell________________
E-Mail________________________________________Web
Address_____________________________
Name of Native
Owner______________________________________Title______________________________
Owner’s Tribal Affiliation___________________________________________________________________________
Tribal Documentation_______________________________________________________________________________
Minority Certifications issued_______________________________________________________________________
Contact
person___________________________________________Title_______________________________
Business Category by Code__________________________________________________________________________
Years in Business___Business
area:____Local____State___Regional____National___International_______
Description of Goods and Services
Offered____________________________________________________
_____________________________________________________________________________________
Signature___________________________________________________________________Date___________________
Print
Name________________________________________________________________Title_____________________
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$125.00 for New General Members (under 50 employees) / $200.00 for General Membership Renewal $1,200.00
for New and Renewal Eagle Members (51+ Employees) Make check
payable (in U.S. Dollars) to: Native
American Business (248)
988-9344-telephone; (248) 988-9348-facsimile NABA is a
501 ( c ) 6 federal tax exemption for all membership dues |