Membership Application

 

 

 

 

Name (Please Print):

Company Name:

Mailing Address:

(Street or PO Box)

City, State, and ZIP

Phone#: fax:

 


Primary Contact: eMail:

 


Type of Business: Year Started:

 


Number of Employees: SIC Code:

 

Certifications: (circle all that apply) Veteran Owned Service Disabled 8(a) HUB Women Owned

 

Minority Owned Other (please specify):

 

Membership Categories Annual Dues

 

US Veteran/Retiree/Active Duty Individual Annual NOT in Business $10.00

US Veteran/Retiree/Active Duty Individual Lifetime NOT in Business $25.00

Veteran Owned Business Annual $25.00

Veteran Owned Business Lifetime $100.00

Associate Member (Non-Veteran Annual) $50.00

Associate Member (Non-Veteran One-Time Lifetime) $150.00

 

Signature: Date:

 

Note: Verification of status may be necessary to process application A copy of DD214 VA Award Letter or appropriate identification DO NOT SEND ORIGINALS.

 

Mail completed application and payment to address listed below dues MAY be deducted as an ordinary and necessary business expense but are NOT deductible as a charitable deduction for federal Income tax purposes.