First Name	Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Last Name	Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Title	Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Email	Required Please enter a valid number Please enter a valid date Please enter valid credit card information

First Name	Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Last Name	Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Title	Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Email	Required Please enter a valid number Please enter a valid date Please enter valid credit card information

First Name	Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Last Name	Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Title	Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Email	Required Please enter a valid number Please enter a valid date Please enter valid credit card information

First Name	Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Last Name	Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Title	Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Email	Required Please enter a valid number Please enter a valid date Please enter valid credit card information

First Name	Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Last Name	Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Title	Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Email	Required Please enter a valid number Please enter a valid date Please enter valid credit card information

The contents of this box are for testing purposes. This box will be removed when the form goes live.
Full-Time Employees Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Part-Time Employees Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Hotel/Motel Rooms Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Restaurant Seats Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Additional Associates Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Additional Associates Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Additional Locations Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Additional Locations Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Assets Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Assets Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information
AdditionalCategories Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Additional Categories Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information
NumberOfAdditionalCategories Required Please enter a valid number Please enter a valid date Please enter valid credit card information
additionalItem1Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information

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Annual Dues (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Tax (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information
Fee (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information

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tempValueForDropDown1 Required Please enter a valid number Please enter a valid date Please enter valid credit card information None Selected Basic ($330/yr) Engaged ($696/yr) Premier ($1500/yr) Bronze ($3000/yr) Silver ($6000/yr) Gold ($10000/yr) Platinum ($15000/yr) Diamond ($20000/yr)

Additional Directory Categories Primary Directory listing is complimentary Up to two additional Directory listings are complimentary After two, additional Directory listings are $35 each
**Hold CTRL on your keyboard to select multiple categories** none
Number of Full Time Employees:
Number of Part Time Employees:
Number of Rooms (Accommodations):
Number of Seats (Restaurants):
Number of Associates (Realtors, Attorneys):
Number of Locations ($35/add. location):
Millions in Assets (Financial Institutions):
Enhanced Membership ($50):
Additional Categories Cost	$
One-Time Application Fee	$
Tax	$
Payment Type *	Credit Card Check
NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.