Investor Registration Join or renew now! Membership Registration & Payment HiddenDate* MM slash DD slash YYYY Are you currently a Main Street Investor?* Yes No Business Name Business Name Contact Person* First & Last Name Email Address* Optional: Secondary email or other contact email Are there any changes to your business contact info that we should update? (ie, new address, phone, web/social, etc?) Yes No Please fill out any information that has changed in the past year:Address Phone #*Phone #Fax #Website Facebook Name or Page Link Twitter Handle What date did your business open? Any employee of your business can benefit Emporia by serving on a committee or volunteering. Mark one or more of the committees or options listed below for more information: Design Promotion Business Enhancement Organization Home Based Clean ups Special Events Select your Investment Level* Founder - $5,000.00 Innovator - $1,250.00 Advocate - $600.00 Booster - $300.00 Non-Profit, Home Based or Food Trucks - $150.00 Individual Supporter - Enter any amount - $0.00 Individual Supporter - Enter any amount: Early Bird Discount for FounderAutomatic discount when you register by June 30! $0.00 Early Bird Discount for InnovatorAutomatic discount when you register by June 30! $0.00 Early Bird Discount for Advocate LevelAutomatic discount when you register by June 30! $0.00 Early Bird Discount for Booster LevelAutomatic discount when you register by June 30! $0.00 Early Bird Discount for Non-Profit, Home Based or Food TrucksAutomatic discount when you register by June 30! $0.00 Payment Preference* Pay online now Invoice me the full amount Invoice me quarterly HiddenThis field is required for forms to be submitted without inputting credit card (applies 100% discount if the user chooses to be invoiced) $0.00 Total to be InvoicedTotal Due Today $0.00 Credit Card Cardholder Name Card Details
