Title

Member Application
Business Information

Company Name: *

Leave Blank:

Phone: *

Website: *

Email: *

Business Description (200 char max): *

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words): *

Comments / Questions:

Interested in becoming a Volunteer:

Interested in Sponsoring an Event?:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Social Networking:

LinkedIn Facebook

Primary Contact Information

First Name: *

Last Name: *

Title: *

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title: *

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Automotive Dealership (16): $450.00
New Car / Automotive Dealerihps Bank / Financial Institutions (16): $1,100.00
Banks Clubs, Civic Organizations, Service Organizations (16): $150.00
Health Care / Hospitals/ Nursing Homes (16): $200.00
0-25 Full Time Employess Health Care / Hospitals/ Nursing Homes (16): $300.00
26-50 Full Time Employees Health Care / Hospitals/ Nursing Homes (16): $500.00
51+ Full Time Employees Hotel / Motel / Lodging: $300.00
Individual (16): $50.00
One Person / No Business or Company Names / No Chamber Voting Privileges Industrial / Manufacturing (16): $300.00
0-50 Full Time Employees Industrial / Manufacturing (16): $450.00
51-100 Full Time Employees Industrial / Manufacturing (16): $600.00
100 - 500 Full Time Employees Industrial / Manufacturing (16): $1,500.00
500+ Full Time Employees Press / Media (16): $350.00
Radio / Newspaper / Magazines / etc... Real Estate Firm / Insurance Company: $450.00
Firm / Company Retail / Restaurants / Wholesale / Trades / Attractions / Venues (16) : $200.00
0-25 Full Time Employees Retail / Restaurants / Wholesale / Trades / Attractions / Venues (16): $400.00
26 - 50 Full Time Employees Retail / Restaurants / Wholesale / Trades / Attractions / Venues (16): $450.00
51 - 100 Full Time Employees Retail / Restaurants / Wholesale / Trades / Attractions / Venues (16): $750.00
101 - 150 Full Time Employees Retail / Restaurants / Wholesale / Trades / Attractions / Venues (16): $1,500.00
150+ Full Time Employees Transportation / Taxi / Courier / Trucking (16): $400.00
0 - 25 Full Time Employees Transportation / Taxi / Courier / Trucking (16): $500.00
26+ Full Time Employees Utilities / Telecommunications / Mail Order: $400.00
Electric / Water / Internet / Phone/ Gas/ etc... 0 - 10 Full Time Employees Utilities / Telecommunications / Mail Order: $1,200.00
Electric / Water / Internet / Phone/ Gas/ etc... 11+ Full Time Employees

Payment Option:

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