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New Member Application

(*) Denotes Required Fields

Company Information

Company:

Address Line 1:

Address Line 2:

City:

State:

Zip:

Phone 1:

Phone 2:

Fax:

E-mail:

Web Site:

Online Links:

Business Category #1:

Please contact us with questions regarding business categories.

Full-time Employees:

Part-time Employees:

Members-only Access

Members-only allows you to update your information online via a secure login.

Admin E-mail:

Password:

Verify Password:

Primary Contact Person

Prefix:

First Name:

Last Name:

Suffix:

Familiar Name:

Title:

Use Company contact information above.

Address Line 1:	*

Address Line 2:
City:	*
State:	*

Zip:	*

Phone 1:	*

Phone 2:

Fax:

E-mail:	*

Billing Contact Person

Send bills to Primary Contact above.

Prefix:

First Name:

Last Name:

Suffix:

Familiar Name:

Title:

Use Company contact information above.

Address Line 1:	*

Address Line 2:
City:	*
State:	*

Zip:	*

Phone 1:	*

Phone 2:

Fax:

E-mail:	*

Additional Company Representatives

Add additional representative.

Prefix:

First Name:

Last Name:

Suffix:

Familiar Name:

Title:

Use Company contact information above.

Address Line 1:	*

Address Line 2:
City:	*
State:	*

Zip:	*

Phone 1:	*

Phone 2:

Fax:

E-mail:	*

Add additional representative.

Prefix:

First Name:

Last Name:

Suffix:

Familiar Name:

Title:

Use Company contact information above.

Address Line 1:	*

Address Line 2:
City:	*
State:	*

Zip:	*

Phone 1:	*

Phone 2:

Fax:

E-mail:	*

Additional Business Information

Additional Business Category(s)

#2:

#3:

Narrative Description:
(200 words max.)

Referred By:

Company:

Dues Schedule

Membership Type

Standard

Annual Investment:

$375.00


	Number of Employees	Amount

	1 thru 5	$375.00
	6 thru 10	$450.00
	11 thru 25	$510.00
	26 thru 50	$575.00
	51 thru 100	$800.00
	101 thru 250	$1,000.00
	Over 250 Employees	$1,300.00

Municipal Membership (Open to NJ municipalities only.)

Associate Membership

Online Directory Listing Logo

South Jersey Tourism Corporation - Add on a membership in the South Jersey Tourism Corporation and promote your business to visitors. Ideal for hotels, restaurants, recreational & entertainment facilities.

Administration Fee

$25.00

Promo Code:	Invalid code.
Administration Fee waived!

__________

Total:

$400.00

Pay Full Amount Up Front

Payment Plan - Requires 50% of the dues plus the Admin Fee at time of sign up. You will be billed 1/12 your annual dues amount each month starting the month after you join.

(*) Denotes Required Fields

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