Member Application:

* Company Name:  
* Phone:  
Website:
* Email:
* Business Description (200 char max)
* Business Keywords:
 
* Physical Address:  
* City/State/Zip:  
Country:
 
Mailing Address: Same as physical address
City/State/Zip:
Country:
 
Business Category:
* Employees: Full-time:      Part-time: 
Comments/Questions:
 
 

Primary Contact Information:

* Name (First / Last):  /   
* Title:  
* Phone:  
Cell Phone:
Fax:
* Email:  
Contact Preference: Email  Phone
Login:
Password:
 
Social Networking: LinkedIn:
Facebook:
 
Address: Same as Company Address
City/State/Zip:
Country:
 
 

Billing Contact Information:

Same as Primary Contact
* Name (First / Last):  /   
* Title:  
* Phone:  
Cell Phone:
Fax:
* Email:  
Contact Preference: Email  Phone
Login:
Password:
 
Social Networking: LinkedIn:
Facebook:
 
Address: Same as Company Address
City/State/Zip:
Country:
 
 
Membership Package:
Basic Membership Package: $325.00
2-5 EE's
Basic Pac-Add'l Employees 6 or more : See fee schedule to determine the fee and enter it below.
Associate Member : $185.00
Agent, Broker or Satellite location of a current VPCC Member- Up to 5 Employees
Associate Member-Add'l Employees 6 or more: See fee schedule to determine the fee and enter it below.
Sole Proprietor: $225.00
Sole Proprietor-1 Employee
Non-Profit Organization: $275.00
Must be a 501(c)(3)
Individual Member: $185.00
Not in workforce/retired

        If using fee schedule, enter fee here:

Additional Fees:
Admin Fee
Initial Set Up Fee
Additional Opportunities:
We will contact you with additional information.
Web Link
$25.00 fee
Payment Option:
Charge my credit card
 
 
Submit Application:
Enter the CAPTCHA words, then press the Submit Application button.
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