Member

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max):

Directory Category: *

Employees:

Full-time Part-time

Comments / Questions:

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: *

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: *

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: *

Tier 1: $200.00
Please refer to Membership Benefits sheet for Tier 1 package details. Tier 2: $350.00
Please refer to Membership Benefits sheet for Tier 2 package details. Tier 3: $550.00
Please refer to Membership Benefits sheet for Tier 3 package details. *Companies/organizations with 50+ employees must begin at this level.* Tier 4: $1,000.00
Please refer to Membership Benefits sheet for Tier 4 package details. Tier 5: $1,500.00
Please refer to Membership Benefits sheet for Tier 5 package details.

Additional Fees:

Processing Fee : $25.00
(One time application processing fee)

Additional Opportunities:

We will contact you with additional information.

Enhanced Membership : $100.00
Enhanced online profile Ribbon Cutting : $200.00
Ribbon Cutting for Grand Opening or Anniversary

Payment Option:

Bill me Charge my credit or debit card

Member Application

Mailing Address

Address

Address