Date Format: MM slash DD slash YYYY
Type of Membership Desired * Business Organization Resident Other Annual Membership Dues
(cost for a year membership)
(optional monetary donation)
Total Amount Due:
Add Membership Dues + Donation (if any) for total.
Payment must be made below by using PayPal after completing form. If you do not pay, you are not registered.
Do you reside or have a business/organization in West Babylon? * Yes No Business Name or Person's Name (if individual) * Owner's Name * Business Address *
or Home address if individual
Contact Full Name * Nearest Intersection *
(across from, located in __________ plaza)
Business Phone # *
(or Home phone if individual)
Email Address *
(Email where customers can contact business w questions)
Cell Phone # * Type of Business *
(Bakery, Deli, Auto Repair Shop)
Your Business Website
Year Business was Established Years at this Address * Business Information / Description *
Your business will be highlighted on our website with your company logo and specifics. Please type in as much information about your business to describe it to the general public. You may include your tag line (motto), services, products, hours of operations and/or anything desired to advertise your business to our residents.
Company logo / Art File(s)
If you are a business, please send us your company logo and/or any other pictures desired to display about your business on our website. You may send multiple to display a gallery. Original "vector art files" (Adobe Illustrator, eps and/or a high resolution jpg, psd, tiff (300 dpi) are highly recommended. The better the quality graphic - the better!
Accepted file types: (ie, ai, eps, jpg, gif, png, pdf, psd, jpeg, tif). CAPTCHA
This field is for validation purposes and should be left unchanged.