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Prefix

* First

Middle

* Last

Designations

Title

* Business Name

* Business Address

* City

* State

* Zip

* Phone

FAX

* Email

* Type of Business

How Long in Business

Number of Years in the Field

Who Referred You to Boma?

Would You be Interested in Enrolling a Co-Worker at a Reduced Rate?

DEMOGRAPHIC INFORMATION

* Occupation (Check One)

What type of properties do you represent? (Check ALL that apply)

Total Building Rentable Area

Building Office Area (Sq. Ft.)

Building Retail Area (Sq. Ft.)

LEGISLATIVE INFORMATION (Please list the address and legislative district for each building that you own or manage. This information will assist us with Advocacy Day.)

BUILDING ONE: Address

BUILDING ONE: Square Footage

BUIDLING ONE: Legislative District

BUILDING TWO: Address

BUILDING TWO: Square Footage

BUILDING TWO: Legislative District

BUILDING THREE: Address

BUILDING THREE: Square Footage

BUILDING THREE: Legislative District

BUILDING FOUR: Address

BUILDING FOUR: Square Footage

BUILDING FOUR: Legislative District

BUILDING FIVE: Address

BUILDING FIVE: Square Footage

BUILDING FIVE: Legislative District

BUILDING SIX: Address

BUILDING SIX: Square Footage

BUILDING SIX: Legislative District

BUILDING SEVEN: Address

BUILDING SEVEN: Square Footage

BUILDING SEVEN: Legislative District

What is your work Legislative District?

What is your home Legislative District?

Please list the names of ALL Elected Officials you know personally.

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