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Primary Contact First Name:*
Primary Contact Last Name:*

Billing Information: (USE THE INFORMATION ON FILE WITH THE CREDIT CARD YOU ARE USING)

Business Name:*
Billing Mailing Address:*
Billing City:*
Billing State:*
Billing Zip Code:*

Physical Address:
Physical City:
State:
Zip Code:
Primary Phone:*
Fax:
Cell Phone:
Contact Preference:	Email Fax Phone
E-mail:*
Website:
Number of Employees:*	Full-Time Part-Time
Type of Business:*
How long has the company been in business?*
Business Description: You have characters left.
Membership:	Type A Membership - $300 Partnerships, Sole Proprietors, Corporations and organizations that are for profit businesses Type B Membership - $475 Financial institutions ($300 for additional locations) car dealerships ($300 for additional brands) utilities, country clubs, developers, RV resorts, mobile home parks, retail complex mngmt offices, apartments, and timeshares. Type C Membership - $515 with Add on Hotels, Motels, Resorts, Casinos 1 to 25 rooms add $3 per room 25 to 100 rooms add $2 per room 100+ rooms add $1 per room Number of Rooms(For Type C Membership): Type D Membership - $200 Individual members Individual/Supporter/Social Business Support Membership 2nd business or location for existing, member non-profit organizations, 501 c (3) individuals. Individual/Supporter.
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Expiration Date:*	/

	Additional $50.00 administration fee is applied