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Member Application

Business Information

Company Name: *

Leave Blank:

Phone: *

Email: *

Directory Category:

Employees:

Full-time Part-time

Comments / Questions:

Woman Owned:

Year Established:

Level of Interest:

Who Refereed You to Join? :

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: *

Primary Contact Information

First Name: *

Last Name: *

Phone: *

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Membership Package: *

Supporter: $360.00
1 Online Category Listing, 1 Printed Directory Listing, Discounted Use of Community Room Associate: $480.00
2 Online Category Listings, 2 Printed Directory Listings, Discounted Use of Community Room Advocate: $720.00
3 Online Category Listings, 3 Printed Directory Listings, Discounted Use of Community Room, 25% Discount on Flyer Insert in Chamber Packet Advisor: $1,000.00
4 Online Category Listings, 4 Printed Directory Listings, Discounted Use of Community Room, 50% Discount on Flyer Insert in Chamber Packet Premier: $2,000.00
6 Online Category Listings, 6 Printed Directory Listings, Discounted Use of Community Room, 1 Free Flyer Insert in Chamber Packet, Complimentary Use of Boardroom Executive Premier: $3,600.00
6 Online Category Listings, 6 Printed Directory Listings, Complimentary Use of Community Room, 2 Free Flyer Inserts in Chamber Packet, Complimentary Use of Boardroom Chairman's Circle: $6,000.00
Unlimited Online Category Listings, Unlimited Printed Directory Listings, Complimentary Use of Community Room, 3 Free Flyer Inserts in Chamber Packet, Complimentary Use of Boardroom

Payment Option:

Bill me Charge my credit or debit card

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