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MEMBERSHIP ENROLLMENT FORM
PLEASE ENROLL MY BUSINESS INSIDE TheCHICAGOLANDirectory.com
This form must be faxed to (773) 695.3889 or mailed to TheChicagolanDirectory, P.O. Box 2225, North Lake, IL 60164 with a $39.95 enrollment fee via check or money order payable to TCD.
Your name: ___________________________________
Type of Business: ___________________________________
Business name: ___________________________________
Business address: ___________________________________
Web address (if any): _________________________ ($10 linking fee)
City _________________________ (if Chicago N-S-EorW)
Phone: _________________________
Email : (if any): _________________________
How did you hear about us: ____________________________________________
My ad should read as follows:
____________________________________________________________________
Signature: _____________________________ Date: _________
WE RESERVE THE RIGHT TO PLACEMENT AND EDITING OF YOUR AD.
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