Member - Midland Business Alliance

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description:

Directory Category:

Employees: *

Full-time Part-time

Business Keywords (enter a space between words):

Comments / Questions:

Why are you joining the MBA?:

Who referred you to the MBA?:

Do any of the following special interest groups apply?:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1:

Line 2:

City:

State:

Postal Code:

Country:

Social Networking:

LinkedIn Facebook Twitter YouTube Pinterest Instagram GooglePlus Snapchat

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Up to 8 Employees: $275.00
Two part-time employees = 1 full-time employee 9-16 Employees: $425.00
Two part-time employees = 1 full-time employee 17-25 Employees: $600.00
Two part-time employees = 1 full-time employee 26-49 Employees: $850.00
Two part-time employees = 1 full-time employee 50-60 Employees: $1,250.00
Two part-time employees = 1 full-time employee Over 60 Employees: Please contact us to determine the fee.
Two part-time employees = 1 full-time employee Non-Profit Organizations 501(c)(3): Please contact us to determine the fee.

Additional Fees:

Application Fee : $40.00
One-time application processing fee

Payment Option:

Bill me Charge my credit or debit card

Member Application

Mailing Address

Address

Address