Membership Application

Become part of the independent retail solution for $125/year. Join fellow independent board sport retailers in the common cause of promoting your business, voicing concerns to manufacturers and trade show representatives alike.

Simply fill out the form below and click 'Submit' to apply for membership in the Board Retailers Association. Annual dues are $125 per year. All potential members are subject to approval by BRA administration. You will be notified of approval and provided access to the 'Members Only' features of this website.

	*  = required field
*Company Name :
Primary Type of Business or Service Offered:	check all that apply:
	Surf Skate	Snow Wake
Number of Locations:
*Representative's First Name:
*Representative's Last Name:
*Phone:
*Email:
URL:	http://
	Mailing Address
Address:
City:
State/Province:
County:
Zip/Postal Code:
Country:
	Membership Dues Retail Member - $125/yr
*Name on Card:
*Card Type:	Select One American Express Mastercard Visa
*Card Number:
*Expiration Date:	Select a Month January February March April May June July August September October November December Select a Year 2008 2009 2010 2011 2012 2013 2014 2015
Coupon Code: *Not Required
	Desired Username/Password
* Username:
*Password:
*Confirm Password:
	Briefly Describe Services Provided:
	I would like to receive Board Retailers Association updates via email.

Please feel free to contact us at info@boardretailers.org.