Membership Application
Contact Person:
Title:
HR Contact Person:
Phone #
Fax #
Mailing Address:
City: State: Zip:
Physical Address:
Cell Phone #:
Website:
E-mail:
How do you prefer to be contacted about urgentbusiness issues and upcoming events?Fax Email Both
Reason for Joining:Networking Credibility Learning Opportunites Gov’t Adocacy Insurance & Discounts Community Involvement Other
Business Classification: (Classifications are the same as the Yellow Pages)
Number of employees: Full-time: Part-time:
Brief description of your business 20 words max. (This will be part of your listing on our web page. We reserve the right to edit for space if necessary.)
Membership Investment:
Employees:
1-4 $220.00 80-99 $720.00 Non-Profit $220.00 5-9 $245.00 100-149 $800.00 Individual $115.00 10-19 $285.00 150-199 $885.00 Associate $115.00 20-29 $355.00 200-249 $970.00 Out of Town $220.00 30-39 $425.00 250-299 $1055.0040-49 $505.00 300-399 $1230.00 *2 Part-Time = 1 Full Time 50-59 $545.00 400-499 $1395.00 60-69 $600.00 500-999 $1705.0070-79 $660.00 1000 + $2840.00
Total Investment (payable at Application)$
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