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Membership Form
Contact Information
Organization Name
*
Primary Contact Name
*
First Name
Last Name
Job Title
*
Email
*
Phone
*
Address
*
Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
Billing Contact Name (if different from Primary Contact)
First Name
Last Name
Street Address (if different from mailing address)
Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
Membership Info
*Solopreneur level is available to sole proprietor and consultants, with no employees.
Amount
*
$
10,000
-
Economic Partner
$
5,000
-
Community Leader
$
2,500
-
Executive
$
1,200
-
Partner
$
600
-
Contributor
$
300
-
Associate
$
150
-
*Solopreneur
Primary Business Category/Business Sector
*
Website
Website hyperlinks are included in members' directory listing at Contributor ($600) Level and above.
Number of Full-Time Employees
Number of Part-Time Employees
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Logo
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