Member Application
Business Information
Company Name:
*
Leave Blank:
Phone:
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Website:
Email:
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Business Description (200 char max):
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Directory Category:
--- Select Primary Category ---
Accounting
Addiction Recovery
Animal Welfare
Apartments
Attorney at Law
Auto Parts
Auto Repairs & Parts
Banking
Bed & Breakfast
C.P.A.
Catering
Chamber Publishers
Charity
Church
Community Market
Community Outreach
Computer Repairs
Conference/Camp Center
Construction
Credit Union
Day Care
Denture Lab
Dept Store
Emergency Vehicles Sales & Repairs
Exercise
Exploration Research
Fast Food
Finance Company
Financial Instituition
Flea Market/Antiques/Cafe
Foundation
Funeral Home
Gas/Convenience Store
Grocery Store
Hardware & Lumber
Health & Rehab
Health Care
Hospital
Individual
Individuals
Insurance
Investments Consultant
LawnCare/Landscaping
Library
Lumber Manufacturer
Manufacturing
Marketing/Webdesign
Medical
Medical Complex
Membership Directory
Municipality
Museums
New & Used Antiques, Handcrafted, Collectibles
Newpaper
Parish Government
Pawn Shop
Pharmacy
Photography
Physical Therapy
Portable Buildings
Public School
Real Estate
Refexology/Massage
Resturant
Retail
Rural Housing Authority
Signs
Sporting Firearms & Supplies
State Government
State of La Mental Health Hospital
Timber
Timber/Real Estate
Tire Shop
Trucking
Uncategorized
Underwater Research
Utilities
Veterinary
Vo-Tech College
Welding
Winery
Employees:
Full-time
Part-time
Comments / Questions:
Physical Address
Line 1:
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Line 2:
City:
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State:
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Postal Code:
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Country:
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--- Select Country ---
Afghanistan
Albania
Algeria
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Belgium
Belize
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Bhutan
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Bosnia and Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Cambodia
Cameroon
Canada
Caribbean
Chile
China
Colombia
Congo (DRC)
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Czechia
Denmark
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Ecuador
Egypt
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Eritrea
Estonia
Ethiopia
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Finland
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Jordan
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Latin America
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Myanmar
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Peru
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South Africa
South Sudan
Spain
Sri Lanka
Sweden
Switzerland
Taiwan
Tajikistan
Thailand
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Tunisia
Türkiye
Turkmenistan
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Venezuela
Vietnam
World
Yemen
Mailing Address
Same as physical address
Line 1:
Line 2:
City:
State:
Postal Code:
Country:
--- Select Country ---
Afghanistan
Albania
Algeria
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Belgium
Belize
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Cambodia
Cameroon
Canada
Caribbean
Chile
China
Colombia
Congo (DRC)
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Czechia
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Faroe Islands
Finland
France
Georgia
Germany
Ghana
Greece
Greenland
Guatemala
Haiti
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea
Kuwait
Kyrgyzstan
Laos
Latin America
Latvia
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia, FYRO
Malaysia
Maldives
Mali
Malta
Mexico
Moldova
Monaco
Mongolia
Montenegro
Morocco
Myanmar
Nepal
Netherlands
New Zealand
Nicaragua
Nigeria
Norway
Oman
Pakistan
Panama
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Réunion
Romania
Russia
Rwanda
Saudi Arabia
Senegal
Serbia
Singapore
Slovakia
Slovenia
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sweden
Switzerland
Taiwan
Tajikistan
Thailand
Trinidad and Tobago
Tunisia
Türkiye
Turkmenistan
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Venezuela
Vietnam
World
Yemen
Social Networking:
LinkedIn
Facebook
Primary Contact Information
First Name:
*
Last Name:
*
Title:
*
Phone:
*
Cell Phone:
Fax:
Email:
*
Contact Preference:
Email
Phone
Login:
*
Password:
*
Social Networking:
LinkedIn
Facebook
Address
Same as Member Address
Line 1:
*
Line 2
City:
*
State:
*
Postal Code:
*
Country:
*
--- Select Country ---
Afghanistan
Albania
Algeria
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Belgium
Belize
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Cambodia
Cameroon
Canada
Caribbean
Chile
China
Colombia
Congo (DRC)
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Czechia
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Faroe Islands
Finland
France
Georgia
Germany
Ghana
Greece
Greenland
Guatemala
Haiti
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea
Kuwait
Kyrgyzstan
Laos
Latin America
Latvia
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia, FYRO
Malaysia
Maldives
Mali
Malta
Mexico
Moldova
Monaco
Mongolia
Montenegro
Morocco
Myanmar
Nepal
Netherlands
New Zealand
Nicaragua
Nigeria
Norway
Oman
Pakistan
Panama
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Réunion
Romania
Russia
Rwanda
Saudi Arabia
Senegal
Serbia
Singapore
Slovakia
Slovenia
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sweden
Switzerland
Taiwan
Tajikistan
Thailand
Trinidad and Tobago
Tunisia
Türkiye
Turkmenistan
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Venezuela
Vietnam
World
Yemen
Billing Contact Information
Same as Primary Contact
First Name:
*
Last Name:
*
Title:
*
Phone:
*
Cell Phone:
Fax:
Email:
*
Contact Preference:
Email
Phone
Login:
*
Password:
*
Social Networking:
LinkedIn
Facebook
Address
Same as Member Address
Line 1:
*
Line 2
City:
*
State:
*
Postal Code:
*
Country:
*
--- Select Country ---
Canada
United States
Membership Options
Membership Package:
*
Business Memberships
:
$200.00
Business Membership
Non-Profit Memberships
:
$150.00
Non- Profit Membership
Individual Memberships
:
$50.00
One Person Membership
Individual Memberships
:
$100.00
Double/Couples Membership
Payment Option:
Charge my credit or debit card
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