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 is the e-mail address that we will publish in the Membership Roster. (You can choose to make both e-mail addresses the same)
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