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Membership Application
Business Name:
Business Address:
Phone Number:
Fax Number:
Email Address
Business Type"
Discription of Business
Number of Employees and Investment Schedule:
1-5 employees $199.00
6-15 employees $239.00
16-25 employees $269.00
26-50 employees $299.00
51-99 employees $399.00
100-150 employees 429.00
151-200 employees $499.00
201-250 employees545.00
251-350 employees 649.00
351-450 employees749.00
Over 551 employees $950.00
Gift Certificate Program is an addtional $35.00
Primary Contact Name:
Primary Contact Email:
Secondary Contact Name:
Secondary Contact Email:
Referred By:
P.O. Box 168, 208 South Jackson St., Auburn, IN 46706
Phone: (260) 925-2100, Fax: (260) 925-2199
