Full Business Name
Contact Name *
Business Address
Town
State
Zip
Telephone
Ext.
Fax	A fax number is requested as we need at least one physical method of contact for your business.
Contact E-Mail	This is the e-mail address we will use for sending our communications to you.
Published Email	This email will be included in the Member Directory so that other members may contact you for personal or professional reasons. You may choose not to provide this information; by providing it you signify your understanding & acceptance of the policy.
Web Site (URL)
Primary Classification	Please select one categoryAnimal ServicesBusiness ServicesChildren's ServicesCommunicationsComputersConstruction/ContractorsEngineeringEntertainmentEnvironmental ServicesFinancial ServicesFood IndustryFuneral ServicesHealth CareHorticultural ServicesIndividualInsuranceLegal ServicesLodgingMaintenanceManufacturers/DistributorsNon-ProfitOtherPersonal ServicesPhotographic ServicesPublic RelationsReal EstateRestaurantsRetail SalesRetirement CommunitiesTravelUtilitiesVehicles: Sales, Leasing, Service, Towing
Secondary Classification	Add search words that describe your profession here.
Number of Full time Employees *	(Two Part Time=One Full Time)
Reason(s) for joining
Dues Schedule - Please select one of the following Membership Categories	Owner/Operator $150.00 1 - 4 Employees $220.00 5 - 8 Employees $330.00 9 - 12 Employees $455.00 12 or more Employees $530.00 Personal Member (non-business listing) $80.00 Community Organization $105.00
Home Address- The following information is for office files only
Home Phone
Spouse's Name