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Connecting Businesses in Fairborn, Ohio

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Fairborn, OH
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New Member Application

Company Information
Company:
*
Address Line 1:
*
Address Line 2:
City:
*
State:
*
Zip:
*
Phone 1:
*
Phone 2:
Fax:
E-mail:
*
Website:
Bus. Category 1:
Full-time Employees:
*
Part-time Employees:
*
Established Date:
Create Member Account Login
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Admin E-mail:
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Password:
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Verify Password:
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Contacts
Primary Contact
Prefix:
First Name:
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Last Name:
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Suffix:
Familiar Name:
Title:
Create Login
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Username:
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Password:
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Verfiy Password:
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Billing Contact
 
Annual Membership Levels
# Employees
Annual Dues
1-4
185.00
5-10
250.00
11-25
275.00
26-50
325.00
51-100
400.00
101-500
500.00
501+
550.00
185.00
550.00
150.00
$225.00 + $1.00 per room
225.00
$275 + $5 per full-time employee (2 part time empoyees equals 1 full-time employee)
275.00
$275.00 + $50.00 per associate + $5.00 per full-time employee (2 part-time employees equals 1 full-time employee)
275.00
100.00
Total:
$0.00
Security Code:
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