Member

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

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:

Primary Contact Information

First Name: *

Last Name: *

Phone: *

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook Twitter YouTube

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Membership Package: *

Individual Networking Membership: $100.00
Individuals will receive membership rates for the annual dinner and monthly luncheons. However, they are not eligible for sponsorships or member listings. Tier 1: 1-9 Employees: $150.00
Small business with 1-9 employees or non-profit organizations Tier 2: 10-35 Employees: $275.00
Small business with 10-35 employees Tier 3: 36-99 Employees: $345.00
Small business with 36-99 employees Tier 4: 100+ Employees: $500.00
Business with 100+ employees

Additional Fees:

One-time Administrative Fee : $25.00
One-Time New Member Administrative Set-Up Fee

Payment Option:

Bill me Charge my credit or debit card

Member Application

Mailing Address

Address