
	Membership data form below

Membership is open all gay and gay friendly businesses and individuals.

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Membership Application

Please complete the following information then send. You will be contacted to confirm the information and Membership type. Thank you for joining Ambiente Puerto Vallarta. We hope you as well as the organization will benefit.
MEMBERSHIP APPLICATION

Membership Type		Additional Member
Business Name		If Yes, # Added Members
Year Business Established		*Founder's Club

Primary Member		Second Member
Your Name		2nd Name
Your Email		2nd Email
Your Title		2nd Title
Address		2nd Address
City		2nd City
State		2nd State
Zip or CP		2nd Zip
Home Phone		2nd Home Phone
Work Phone		2nd Work Phone

Web site 1
Web site 2
Business Type
Referred By
Please provide a 2-3 sentence description of your business for Ambiente Puerto Vallarta web site directories and other Member listings.

Please provide Directions to your Location or a Description of how the business can be located.

Please answer Yes or No to the following:

	Contact Me, I have input & questions for Ambiente Puerto Vallarta
	Contact Me, I would like to Host a Ambiente Puerto Vallarta Fundraiser
	Contact Me, I would like to Host a Monthly Luncheon
	Contact Me I would like to Present on a Business Topic at the Monthly Luncheon - 15 Minutes + Q&A
	Send Email re Ambiente Puerto Vallarta News and Events
	Do you Check Email Daily?
	List Name 1
	List Name 2
	List Business Name
	List Business Address/Location
	List Business Web Site(s)
	Keep All of My Information Confidential

* Platinum, Gold, Silver and Benefactor Members are automatically Members of the Founder's Club. If you have a Bronze or Personal Membership and would like to be a Member of the Founder's Club, Select the Founder's Club as an addition to your Membership. Bronze Members who join the Founder's Club will be changed to Gold level Members.

**Please provide Business address for Business and Non-Profit Memberships and Home Address for Personal Memberships. All information is confidential unless specific permission is granted for use in Ambiente Puerto Vallarta marketing materials including the web site. Ambiente Puerto Vallarta staff may make deliveries to you or pick ups and from time to time you may receive a mailing regarding Ambiente Puerto Vallarta business or events.

Send mail to info@pvglba.org with questions or comments about this web site. All content is property of Ambiente Puerto Vallarta and may be copied with permission. Please contact us to explain the purpose of your use.