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 RequiredPlease enter a valid numberPlease enter a valid datePlease enter valid credit card information
Part-Time Employees RequiredPlease enter a valid numberPlease enter a valid datePlease enter valid credit card information
Hotel/Motel Rooms RequiredPlease enter a valid numberPlease enter a valid datePlease enter valid credit card information
Restaurant Seats RequiredPlease enter a valid numberPlease enter a valid datePlease enter valid credit card information
Additional Associates RequiredPlease enter a valid numberPlease enter a valid datePlease enter valid credit card information
Additional Associates Cost RequiredPlease enter a valid numberPlease enter a valid datePlease enter valid credit card information
Additional Locations RequiredPlease enter a valid numberPlease enter a valid datePlease enter valid credit card information
Additional Locations Cost RequiredPlease enter a valid numberPlease enter a valid datePlease enter valid credit card information
Assets RequiredPlease enter a valid numberPlease enter a valid datePlease enter valid credit card information
Assets Cost RequiredPlease enter a valid numberPlease enter a valid datePlease enter valid credit card information
AdditionalCategories RequiredPlease enter a valid numberPlease enter a valid datePlease enter valid credit card information
Additional Categories Cost RequiredPlease enter a valid numberPlease enter a valid datePlease enter valid credit card information
NumberOfAdditionalCategories RequiredPlease enter a valid numberPlease enter a valid datePlease enter valid credit card information
additionalItem1Cost RequiredPlease enter a valid numberPlease enter a valid datePlease enter valid credit card information

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Annual Dues (charged to card) RequiredPlease enter a valid numberPlease enter a valid datePlease enter valid credit card information
Tax (charged to card) RequiredPlease enter a valid numberPlease enter a valid datePlease enter valid credit card information
Fee (charged to card) RequiredPlease enter a valid numberPlease enter a valid datePlease enter valid credit card information

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tempValueForDropDown1 RequiredPlease enter a valid numberPlease enter a valid datePlease enter valid credit card information
MembershipType RequiredPlease enter a valid numberPlease enter a valid datePlease enter valid credit card information

Number of Locations ($25/add. location):
Enhanced Membership ($50):
One-Time Application Fee	$
Number of Rooms (Accommodations):
Number of Seats (Restaurants):
Number of Associates (Realtors, Attorneys):
Millions in Assets (Financial Institutions):
Additional Categories Cost	$
Additional Mailings ($25 each):
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.
New Member Processing Fee ($25):	$