Membership Application

Business Name:

Contact Name:

Mailing Address:

Street Address:

Phone Number:

Fax Number:

Email:

Website:

The Dues for one General Voting Membership are $100.00.

If you would like to have any of your employees listed as voting members
there is an additional $10.00 per employee fee.
Those listed will be entitled to one vote.

Number of Additional Voting Members? 0 1 2 3 4 5 6 7 8 9 10

Enter the Additional Voting Member names below. (If applicable)