Membership Application

Company Name: 

Contact Person:

Title:  

HR Contact Person:

Phone # 

Fax # 

Mailing Address:

City:    State:   Zip:

 Physical Address:

City:    State:    Zip:

Cell Phone #: 

 Website:

E-mail: 

How do you prefer to be contacted about urgent
business 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 $1055.00
40-49 $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 $1705.00
70-79 $660.00           1000 +  $2840.00
 

Total Investment (payable at Application)$