Membership Registration Join or renew now! Membership Registration & Payment Are you currently a Main Street Member?* Yes No Business Name Business Name Contact Person* First & Last Name HiddenDate* MM slash DD slash YYYY Address Phone #*Fax #Email Address* Website Facebook Name or Page Link Twitter Handle 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 Membership Level* President's Circle - $1,250.00 Benefactor - $600.00 Patron - $300.00 Non-Profit, Home Based or Food Trucks - $150.00 Fab Lab Only Individual Supporter - Enter any amount Individual Supporter - Enter any amount: Early Bird DiscountAutomatic discount when you register by June 30! $0.00 Early Bird DiscountAutomatic discount when you register by June 30! $0.00 Early Bird DiscountAutomatic discount when you register by June 30! $0.00 Early Bird DiscountAutomatic 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
