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Organization Information (to be displayed online) Organization Name Address 1 Address 2 City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Phone Fax Website Email Main Contact Copy from Organization-Information First Name Last Name Address 1 Address 2 City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Title Phone Email Additional Contacts Contact 1 First Name Last Name Title Email Address Contact 2 First Name Last Name Title Email Address Contact 3 First Name Last Name Title Email Address Contact 4 First Name Last Name Title Email Address Contact 5 First Name Last Name Title Email Address Contact 6 First Name Last Name Title Email Address Contact 7 First Name Last Name Title Email Address Contact 8 First Name Last Name Title Email Address Contact 9 First Name Last Name Title Email Address Contact 10 First Name Last Name Title Email Address Add/Remove Contacts Billing Address (if different) Address 1 Address 2 City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Mailing Address (if different) Address 1 Address 2 City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Additional Information Referred By How did you hear about us? What is your reason for joining? Please have someone contact me regarding Business Resources Community Involvement Cost Savings Programs Economic Development Government Relations Networking Training Opportunities Other Membership Investment Membership Type Select One... Restaurant Bar/Tavern Hotel/Lodging Allied Restaurant/Bar/Tavern - Food & Beverage Sales (choose one) $499,999 and under : $350 $500,000 - $999,999 : $475 $1M - $2,999,999 : $695 $3M - $4,999,999 : $995 $5M - $9,999,999 : $1,650 $10M - $19,999,999 : $2,750 $20M - $39,999,999 : $3,850 $40M+ : $4,950 Hotel/Lodging (choose one) 1-50 rooms : $295 51+ rooms limited service : $5.75/room (no sale of food & beverage) 51+ rooms full service: $8.75/room (sale of food & beverage) Lodging/Hotel Multiple property discounts 2-5 properties - 10% 6-10 properties - 20% 11+ properties - 30% Allied (choose one) Regular : $500 Supporter : $750 Patron : $1,250 Benefactor : $2,500 Educational Institution : $300 CVB/Chamber : $500 Selected Type: Please select from the list above. Number of Rooms Number of Locations Annual Membership Investment Total The contents of this box are for testing purposes. This box will be removed when the form goes live. Full-Time Employees Part-Time Employees Hotel/Motel Rooms Restaurant Seats Additional Associates Additional Associates Cost Additional Locations Additional Locations Cost Assets Assets Cost Additional Categories Number Of Additional Categories Additional Categories Cost Additional Item 1 Cost Additional Item 2 Cost Additional Item 3 Cost Additional Item 4 Cost Additional Item 5 Cost Additional Item 6 Cost Additional Item 7 Cost Additional Item 8 Cost Additional Item 9 Cost Additional Item 10 Cost Annual Dues (charged to card) Revenue Item Tax (charged to card) Fee (charged to card) Temp Value For DropDown 1 MembershipType Additional Item 1 Additional Item 2 Additional Item 3 Additional Item 4 Additional Item 5 Additional Item 6 Additional Item 7 Additional Item 8 Additional Item 9 Additional Item 10 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. Number of Full Time Employees Number of Part Time Employees Additional Directory Categories Select additional directory categories below by holding the "CTRL" key Secondary categories may be subject to additional fees none Additional Items Additional Categories Cost One-Time Application Fee Tax Food & Beverage Sales Membership Type Select one... Restaurant (per sales) Lodging 1-50 rooms Lodging, Limited Service (per room) Lodging, Full Service (per room) Regular $500 Supporter $750 Patron $1250 Benefactor $2500 Education Member $300 CVB/Chamber $500 Number of Seats Number of Associates Primary Directory Category None Bar Only - No Food Service Catering Fast Casual Fast Food Full Service Credit Card Information Copy from Organization Information Credit Card Type MastercardVisaDiscoverAmex Credit Card Number Name on Card Security Code Valid Through 01 02 03 04 05 06 07 08 09 10 11 12 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 Address City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Phone Credit Card Email Address Please click submit only one time. 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