Minority Business Advocacy Council
Membership Form

Company Name __________________________________________________________

Point of Contact __________________________________________________________

Business Address ________________________________________________________

City ________________________________ State ___________ Zip __________

Business Phone _____________________________ Fax ________________________

E-mail Address _____________________________ Business Web Address __________

Description of Services

________________________________________________________________________

Membership Fee: $25.00 REFERRED BY MBAC MEMBER: __________________

PLEASE MAKE CHECK PAYABLE TO:

MBAC

P.O. Box 217, White Plains MD 20695

Phone: 301-752-3915