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Member Application

Please note that dues rates may increase effective April 1, 2019. If you would like to pay monthly membership dues please call Fran Diffenderfer at 717.718.7845

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max): *

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words):

Comments / Questions:

School District: *

Municipality: *

Primary Reason for Joining:

Minority Owned:

Woman Owned:

Veteran Owned:

Residential:

Commercial:

Do not publish address:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1:

Line 2:

City:

State:

Postal Code:

Country:

Social Networking:

LinkedIn Facebook Twitter Google+ youtube

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook Twitter Google+ youtube

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

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 Twitter Google+ youtube

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Membership: See fee schedule to determine the fee and enter it below.
Your annual dues are based on your company's employee count. If using fee schedule, enter fee here:

Additional Fees:

Processing Fee : $30.00
New membership processing fee

Payment Option:

Charge my credit or debit card

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144 ROOSEVELT AVENUE
YORK, PA 17401
P: 717.848.4000
F: 717.843.8837

OFFICE HOURS
Mon-Thurs: 8:30 a.m. – 5p.m.
Fri: 8:30 a.m. – 4:30 p.m.

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