Membership Application

Member Name (as it should appear on the WayNet website)

Website Address:

Your First Name

Your Last Name

Your Title

Organization (if applicable)

Street Address

Street Address (2)

City

State

Zip Code

Work Phone

Home Phone

FAX

Your email address

If applicable...

Facebook

Twitter

Membership level dictates the amount of exposure your website link receives on the WayNet site. Choose a membership level, please:

Sponsors are billed on an annual basis; if you are signing up for a Basic or Business Membership, you may indicate if you prefer to be billed

Annually

Quarterly

May we send you WayNet News, a low-volume e-newsletter used to communicate with our members and others interested in Wayne County, Indiana?

Yes! Please do.

No, I don't want to know what's happening with WayNet and Wayne County.

By submitting this form, you agree to pay the membership fee as described above. You understand that non-payment of these fees will result in the removal of your link(s) from the WayNet.org web site. You also agree that you have read and consent to abide by WayNet's Terms of Service.