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:

How did you hear about us/who referred you?:

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: *

Title: *

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook MySpace Twitter Pinterest YouTube

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 MySpace Twitter Pinterest YouTube

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Membership Package: *

For companies with 1 - 10 full-time employees: $450.00
Includes sole proprietors, independent contractors and home based-businesses. For companies with 11 - 50 full-time employees: $600.00
For companies with 51 - 99 full-time employees: $750.00
For companies with 100 - 299 full-time employees: $900.00
For companies with 300+ full-time employees: $1,500.00
Corporate Partner - Gold Level: $2,500.00
Corporate Partner - Platinum Level: $5,000.00
Community Partner: $200.00
Non-business (no business affiliation. Includes retirees, professional in transition and community volunteers). Non-profit Partners: $250.00
Includes 501(c)(3) and 501(c)(6)

Payment Option:

Charge my credit or debit card

Member Application

Mailing Address

Address

Address