APPLY FOR MEMBERSHIP
Printable Mail-in Form
Please Print, then mail to the address above. Thank You
Information provided will be used to establish a basic business record on member forms,
although membership information other than name, representative,
location and business type is confidential.
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Business Name/Type |
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Contact Name |
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Preferred Phone Number |
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FAX Number |
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Pager Number/Toll Free Number |
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Email Address |
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Web Site Address (URL) |
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Address 1 |
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Address 2 |
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City, State, Zip Code |
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Individual |
Manufacturer |
Retail/Service/Professional/Educational |
|
Number of employees (See chart below) ______ |
Former Member? YES NO |
|
Signature:________________________________ |
Date:____________________ |
|
Type of Membership applying for: |
|
Indiviual |
Manufacturer |
Retail/Service/Professional/Educational |
Individual, Farms or
Civic Groups |
Manufacturers |
Retail, Service, Professional,
Educational, and
all others not specified |
|
$50.00 |
25 or less employees |
$200.00 |
1 - 5 employees |
$100.00 |
| 26 - 50 |
$350.00 |
6 - 10 |
$150.00 |
| 51 - 75 |
$400.00 |
11 - 20 |
$200.00 |
| 76 - 100 |
$450.00 |
21 - 50 |
$250.00 |
| 101 - 125 |
$500.00 |
51 - 100 |
$300.00 |
| 125 - 150 |
$550.00 |
101 or more |
$350.00 |
| 151 or more |
$600.00 |
Updated
05/03/2011
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