Member Login ▼

MicroNet Template

Member Application

Click here for more information about our Membership Levels and pricing

Business Information

Company Name: *

Phone: *

Website: *

Email: *

Business Description (200 char max): *

Directory Category:

Employees:

Full-time Part-time

Business Keywords (enter a space between words): *

Comments / Questions:

# of Employees: *

Do you want a new member certificate: *

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Copper: $260.00
Basic package first year Bronze: $385.00
First year Gold: $505.00
First year Platinum: $1,055.00
First year Municipal Government: $350.00
First year Friends of the Chamber: $84.00
Non-business affiliated Non-Profit 501c required: $155.00
First year Premier Platinum: $2,555.00
First year

Payment Option:

Charge my credit or debit card

In the effort to fight spam, please provide the answer to the following question.

What is the sum of 8 plus 1?: *

Print Application

MicroNet Template

Member Application

Mailing Address

Address

Address

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