HOWDY!

Please choose one:

Business

Club or Organization

Submitted by:

First and Last Name:

Position in Business or Organization:

General Information:

Business or Organization:

Street Address:

City: , Missouri - Zip Code:

Product or Service:

Number of employees or members:

Normal Operating Hours/Meeting Times:

Meeting Place: (Optional)

Any Other Information: (Note: This section should give more information about your organization or business. (Feel free to include a mission statement, directions to your location, special times of services/events, anything the general public should know-- no advertising please.)

Phone Numbers: (Optional)

VOICE: Area Code: Phone Number:

FAX: Area Code: Phone Number:

Please choose a Category Below: (Note-- more than one can be chosen.)

Agriculture	Church	Club / Organization
Educational	Entertainment / Recreation	Financial Services
Government	Health / Family Services	Manufacturing
Transportation / Communication	Professional Services	Restaurants / Lodging
Retail / Wholesale	OTHER