Member

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:

Member Source:

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: *

Email: *

Contact Preference:

Email Phone

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: *

Email: *

Contact Preference:

Email Phone

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Additional Fees:

Application Fee - Required for new members : $25.00
Application and Enrollment Fee for your first year of membership

Additional Opportunities:

We will contact you with additional information.

Visionary Member Upgrade - Full Payment Required with Application : $150.00
Includes the following exclusive benefits: 1. Participation in a monthly exclusive Business Resource Council | 2. Two free event tickets (value of $40 or less)| 3. Preferred event seating | 4. Company Recognition at events . | 5. One free electronic ad. | 6. Enhanced website position and increased webpage content. | 7. Concierge service for registration and program updates.

Payment Option:

Bill me Charge my credit or debit card

Member Application

Mailing Address

Address

Address

Connecting Community & Commerce Since 1913.