First Name:            Middle Initial:  

Last Name:    Title:  

Bus. Name:

Bus. Address:

City:       State/Region:

Zip/Postal Code:    Country:

Bus. Ph.: Ext: Home Ph.:

e-Mail:   

Web Site:  

Are you working with a IANetwork Rep. already?   Yes   No

If yes please enter His/Her Name  

What category best describes your business services?

Ballooning           Bed & Breakfast         Biking           Camping

Canoes/Kayaks  Culture/Arts              Eco Tours       Equestrian

Fishing             Golf                          Hang Gliding   Hiking

Hotel/Motel       Laser Tag                  Motor Sports   Paintball

Parasailing       Personal Watercraft    Public Parks    Sailing

SCUBA/Snork.  Skiing                       Skydiving         Travel

Whitewater     Other:

What is the best discount you can offer the IAN Members?

How many Full-time employees do you currently have?