Member

Business Information

Company Name: *

Phone: *

Website:

Email: *

Business Description (200 char max):

Directory Category:

Employees:

Full-time Part-time

Business Keywords (enter a space between words):

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 Twitter Instagram

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook Twitter Instagram

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 Twitter Instagram

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Membership Package: *

Business Advocate: Non-profit: $125.00
Business Advocate: For-profit: $200.00
Business Builder: Non-profit: $150.00
Business Builder: For-Profit: $250.00
Chamber Partner: $350.00
Community Partner: $550.00
Community Builder: $1,000.00
Individual Member: $60.00

Payment Option:

Bill me Charge my credit or debit card

In the effort to fight spam, please provide the answer to the following question.

What is the sum of 2 plus 4?: *

Member Application

Mailing Address

Address

Address