Membership Application Form

Membership Application Form
Premium Membership

COMPANY INFORMATION

Company Name:

Street:

City:

State:

Zip:

URL:

Year Established:

Total Employees:

Total Employees in Region:

Membership Rate:

NAIC Code:

Description of Business, Products or Services (Max. 30 words)

CONTACT INFORMATION

Primary Contact

Name:

Title:

E-mail Address:

Phone:

Fax:

Secondary Contact

Name:

Title:

E-mail Address:

Phone:

Fax:

KEY EXECUTIVES

President:

CEO:

Sales/Marketing:

Human Resources:

MEMBERSHIP RATES

More than 100 employees, please call 412.392.4500 for rates

CATEGORY LIST - Please check the category that best classifies your business:


Accounting	Finances/Banking/Investments
Advertising/Marketing/Public Relations	Gift Baskets
Architecture	Government
Arts/Culture/Museums	Hospitals/Health Care/Professionals
Associations/Organizations	Hotel/Motel/Bed & Breakfast
Athletic Clubs/Fitness Centers/Equipment	Human Resource Services
Attorneys/Legal Services	Import/Export/Trading
Automobiles/Service/Rentals	Insurance Products/Services
Business Services	Libraries
Career Management/Consulting	Manufacturing/Distribution
Catering/Food Service	Media
Chemicals/Allied Products	Office Equipment/Supplies
Church/Religious Organizations	Parking
Cleaning Services	Real Estate/Apartments
Communication Services	Relocation Services
Computer Sales/Service	Repairs/Service
Computer/Information Technology	Restaurants/Night Clubs
Consulting Services	Retail
Contractors/Construction/Equipment	Security/Alarm Services
Copying/Printing	Social Services/Family & Youth Services
Credit Services	Sports/Entertainment
Economic Development	Tourism Promotion
Educational Services/Institutions	Translation Services
Employment Agency/Temporary Agency	Transportation/Moving/Storage
Engineering	Utilities/Related Services
Environmental Services	Wholesalers

MEMBERSHIP RATES

More than 100 employees, please call 412.392.4500 for rates