Name (Please Print):
(Street or PO Box)
City, State, and ZIP
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 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
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.