BABA Membership Form

Join the Bright Area Business Association! Membership includes the listing on the web site and the printed directory! Support our organization for $50 per year! For questions concerning membership, contact Bright Area Business Association c/o Kim Joerger 24048 Stateline Rd. Suite 103 Lawrenceburg IN, 47025.

Name

I am an Individual Organization

PrefixFirst NameMiddle NameLast NameSuffix

Title

Organization

Department

Contact First NameContact Last Name

Image

Select Image:

Maximum upload file size: 256 MB.

Logo

Select Logo:

Maximum upload file size: 256 MB.

Addresses

<div class="widget-title">
				<h4>
					<span class="address-type">
					<input type="hidden" id="cn-address[::FIELD::][type]" name="address[::FIELD::][type]" value="work" /><span class="preferred"><span class="cn-radio-group">
	<span class="cn-radio-option"><input type="radio" id="cn-address[preferred][::FIELD::]" name="address[preferred]" value="::FIELD::" /><label for="cn-address[preferred][::FIELD::]" >Preferred</label></span>
</span></span>
					</span>
					
				</h4>
			</div>

</div>

<div class="address-line"><label for="cn-address[::FIELD::][line_1]" >Address Line 1</label><input type="text" id="cn-address[::FIELD::][line_1]" name="address[::FIELD::][line_1]" value="" /></div><div class="address-line"><label for="cn-address[::FIELD::][line_2]" >Address Line 2</label><input type="text" id="cn-address[::FIELD::][line_2]" name="address[::FIELD::][line_2]" value="" /></div><div class="address-line"><label for="cn-address[::FIELD::][line_3]" >Address Line 3</label><input type="text" id="cn-address[::FIELD::][line_3]" name="address[::FIELD::][line_3]" value="" /></div><div class="address-line"><label for="cn-address[::FIELD::][line_4]" >Address Line 4</label><input type="text" id="cn-address[::FIELD::][line_4]" name="address[::FIELD::][line_4]" value="" /></div>
			</div>

<div class="address-city"><label for="cn-address[::FIELD::][city]" >City</label><input type="text" id="cn-address[::FIELD::][city]" name="address[::FIELD::][city]" value="" /></div><div class="address-state"><label for="cn-address[::FIELD::][state]" >State</label><input type="text" id="cn-address[::FIELD::][state]" name="address[::FIELD::][state]" value="" /></div><div class="address-zipcode"><label for="cn-address[::FIELD::][zipcode]" >Zipcode</label><input type="text" id="cn-address[::FIELD::][zipcode]" name="address[::FIELD::][zipcode]" value="" /></div>
			</div>

<div class="address-latitude"><label for="cn-address[::FIELD::][latitude]" >Latitude</label><input type="text" id="cn-address[::FIELD::][latitude]" name="address[::FIELD::][latitude]" value="" /></div><div class="address-longitude"><label for="cn-address[::FIELD::][longitude]" >Longitude</label><input type="text" id="cn-address[::FIELD::][longitude]" name="address[::FIELD::][longitude]" value="" /></div>
				
			</div>

<input type="hidden" name="address[::FIELD::][id]" value="0">
			
						<p class="cn-remove-button">
				<a href="#" class="cn-remove cn-button button cn-button-warning"
				   data-type="address"
				   data-token="::FIELD::">Remove</a>
			</p>
			
		</div>

Add Address

Phone Numbers

<label for="cn-phone[::FIELD::][type]" >Phone Type</label><select id="cn-phone[::FIELD::][type]" name="phone[::FIELD::][type]" ><option value="cellphone" selected='selected'>Cell Phone</option><option value="workphone" >Work Phone</option></select>
<span class="preferred"><span class="cn-radio-group">
	<span class="cn-radio-option"><input type="radio" id="cn-phone[preferred][::FIELD::]" name="phone[preferred]" value="::FIELD::" /><label for="cn-phone[preferred][::FIELD::]" >Preferred</label></span>
</span></span>

</h4>
			</div>

</div>

<label for="cn-phone[::FIELD::][number]" >Phone Number</label><input type="text" id="cn-phone[::FIELD::][number]" name="phone[::FIELD::][number]" value="" />
			</div>

<input type="hidden" name="phone[::FIELD::][id]" value="0">
			
						<p class="cn-remove-button">
				<a href="#" class="cn-remove cn-button button cn-button-warning"
				   data-type="phone"
				   data-token="::FIELD::">Remove</a>
			</p>
			
		</div>

Add Phone Number

Email Addresses

<input type="hidden" id="cn-email[::FIELD::][type]" name="email[::FIELD::][type]" value="work" /><span class="preferred"><span class="cn-radio-group">
	<span class="cn-radio-option"><input type="radio" id="cn-email[preferred][::FIELD::]" name="email[preferred]" value="::FIELD::" /><label for="cn-email[preferred][::FIELD::]" >Preferred</label></span>
</span></span>

</h4>
			</div>

</div>

<label for="cn-email[::FIELD::][address]" >Email Address</label><input type="text" id="cn-email[::FIELD::][address]" name="email[::FIELD::][address]" value="" />
			</div>

<input type="hidden" name="email[::FIELD::][id]" value="0">
			
						<p class="cn-remove-button">
				<a href="#" class="cn-remove cn-button button cn-button-warning"
				   data-type="email"
				   data-token="::FIELD::">Remove</a>
			</p>
			
		</div>

Add Email Address

Messenger IDs

<label for="cn-im[::FIELD::][type]" >IM Type</label><select id="cn-im[::FIELD::][type]" name="im[::FIELD::][type]" ><option value="aim" selected='selected'>AIM</option><option value="yahoo" >Yahoo IM</option><option value="messenger" >Live Messenger</option><option value="skype" >Skype</option></select>
<span class="preferred"><span class="cn-radio-group">
	<span class="cn-radio-option"><input type="radio" id="cn-im[preferred][::FIELD::]" name="im[preferred]" value="::FIELD::" /><label for="cn-im[preferred][::FIELD::]" >Preferred</label></span>
</span></span>

</h4>
			</div>

</div>

<label for="cn-im[::FIELD::][id]" >IM Network ID</label><input type="text" id="cn-im[::FIELD::][id]" name="im[::FIELD::][id]" value="" />
			</div>

<input type="hidden" name="im[::FIELD::][uid]" value="">
			
						<p class="cn-remove-button">
				<a href="#" class="cn-remove cn-button button cn-button-warning"
				   data-type="im"
				   data-token="::FIELD::">Remove</a>
			</p>
			
		</div>

Add Messenger ID

Links

<label for="cn-link[::FIELD::][type]" >Type</label><select id="cn-link[::FIELD::][type]" name="link[::FIELD::][type]" ><option value="website" selected='selected'>Website</option><option value="blog" >Blog</option></select>
<span class="preferred"><span class="cn-radio-group">
	<span class="cn-radio-option"><input type="radio" id="cn-link[preferred][::FIELD::]" name="link[preferred]" value="::FIELD::" /><label for="cn-link[preferred][::FIELD::]" >Preferred</label></span>
</span></span>

</h4>
			</div>

</div>

<label for="cn-link[::FIELD::][title]" >Title</label><input type="text" id="cn-link[::FIELD::][title]" name="link[::FIELD::][title]" value="" />
			</div>

<span class="target"><label for="cn-link[::FIELD::][target]" >Target</label><select id="cn-link[::FIELD::][target]" name="link[::FIELD::][target]" ><option value="new" selected='selected'>New Window</option><option value="same" >Same Window</option></select></span>
<span class="follow"><select id="cn-link[::FIELD::][follow]" name="link[::FIELD::][follow]" ><option value="nofollow" selected='selected'>nofollow</option><option value="dofollow" >dofollow</option></select></span>

</div>

<label>
					<input type="radio" name="link[image]" value="::FIELD::" >
					Assign link to the image.				</label>
				<label>
					<input type="radio" name="link[logo]" value="::FIELD::" >
					Assign link to the logo.				</label>

</div>
			
						<input type="hidden" name="link[::FIELD::][id]" value="0">
			
						<p class="cn-remove-button">
				<a href="#" class="cn-remove cn-button button cn-button-warning"
				   data-type="link"
				   data-token="::FIELD::">Remove</a>
			</p>
			
		</div>

Add Link

Dates

<label for="cn-date[::FIELD::][type]" >Type</label><select id="cn-date[::FIELD::][type]" name="date[::FIELD::][type]" ><option value="birthday" >Birthday</option><option value="certification" >Certification</option></select>
<span class="preferred"><span class="cn-radio-group">
	<span class="cn-radio-option"><input type="radio" id="cn-date[preferred][::FIELD::]" name="date[preferred]" value="::FIELD::" /><label for="cn-date[preferred][::FIELD::]" >Preferred</label></span>
</span></span>

</h4>
			</div>

</div>

<p class="cn-remove-button">
				<a href="#" class="cn-remove cn-button button cn-button-warning"
				   data-type="date"
				   data-token="::FIELD::">Remove</a>
			</p>
			
		</div>

Add Date

Biographical Info

Notes

Click here to download the Membership Form.

Complete the Membership Form, enclose $50 and send it to:

Bright Area Business Association c/o Kim Joerger 24048 Stateline Rd. Suite 103 Lawrenceburg IN, 47025.

For convenience, click on the “Pay Now” button to pay your membership dues on-line.

Name

Category

Image

Logo

Addresses

Phone Numbers

Email Addresses

Messenger IDs

Links

Dates

Biographical Info

Notes

Click here to download the Membership Form.

Recent News

Sign up for the Bright Area Business Association Newsletter

Categories

Archives

Contact Us

BABA Membership Form

Name

Category

Image

Logo

Addresses

Phone Numbers

Email Addresses

Messenger IDs

Social Media IDs

Links

Dates

Biographical Info

Notes

Click here to download the Membership Form.

Recent News

Sign up for the Bright Area Business Association Newsletter

Categories

Archives

Contact Us