Membership Application

Business Information

Company Name:

Directory Category:

Phone:

Website:

Number of full-time employees:

Number of part-time employees:

Physical Address

Address:

City:

ZIP:

Mailing Address

Same as physical address

Address:

City:

ZIP:

Primary Contact Information

First Name:

Last Name:

Title:

Phone:

Fax:

Email:

Contact Preference(s):PhoneEmail

Address

Same as member address

Address:

City:

ZIP:

Membership Options

Membership Package (prorated for November 2019):Individual: $21; Sole proprietor, no employees1 - 5 Employees: $306 - 10 Employees: $4411 - 20 Employees: $5121 - 50 Employees: $7051 - 100 Employees: $81101 - 200 Employees: $101200+ Employees: $132Trade Association: $62Retiree or non-business individual: $11Not-for-profit, government agency, municipality, or educational institution; see below

50% of appropriate membership package:

Please indicate below if we may share your business information with the general public:Yes, you may release this informationNo, please do not release this information