Highland Business Association

Company Name:^†

Key Contact/Title:^†

Address:^†

Address 2:

City:^†

State:^†

Zip Code:^†

Phone:^†

Fax:

E-mail Address:^†

Website URL:

Industry:

Would you like your information to be shared with other members of the HBA and included on our web site?^†

Dues for 2006 (Prorated Quarterly):^†

I am interested in the following commitee(s):

I am willing to provide the following discounted item(s)/service(s) for my fellow members and potential members during 2006: