PRINT THIS FORM, FILL IT OUT, AND MAIL TO ADDRESS BELOW



Print Name:____________________________________________________      

Home Address:_________________________________________________     

City/Town:_____________________________________________________       

Email (for Federation Business only): _______________________________  

Community (s) Working for: _______________________________________  

Title: ______________________________________   

Please check one:

Member - [   ] -BOWM       [   ] -MBCIA      [   ] -SEMBOA    [   ] -Other____________________

Make your check payable to: MFBO Legislative and Code Action Fund

Mail to:  MFBO   P.O. Box 466  Ashfield, MA  01330

-----THANK YOU!----