New Member Application

Your Information

This section for membership account contact information. Business/Company information is entered on the next page.

Name of Applicant(Required)

First Middle Last

Birthday: Month(Required)

Birthday: Day(Required)

Phone(Required)

Phone 2

Email(Required)

Enter Email Confirm Email

Address(Required)

Street Address Address Line 2 City State ZIP Code

Spouse's First Name

Are YOU a property owner in South Jacksonville?(Required)

Yes

Are YOU actively engaged in business in South Jacksonville?(Required)

Yes

Who sponsored your application for membership?(Required)

First Middle Last

Business Information

Tell us about your business.

Name of Business/Company(Required)

Business Type(Required)

Other

Describe your business in 2-3 words.

Alternate Member Information

For an alternate/approved company representative.

Yes. Use/add the following individual.

Alternate Member Name(Required)

First Middle Last

Birthday: Month(Required)

Birthday: Day(Required)

Phone(Required)

Phone 2

Email(Required)

Enter Email Confirm Email

Address(Required)

Street Address Address Line 2 City State ZIP Code

Property owner in South Jacksonville?(Required)

Yes

Actively engaged in business in South Jacksonville?(Required)

Yes

How name and company should appear on member badge.(Required)

Business Phone(Required)

Your business phone number.

Business Fax

Your business fax number.

Website

Business Email(Required)

Your company's general contact email address.

Business Address Type(Required)

Brick & Mortar Store

Correspondence Only

Other

Business Address(Required)

Street Address Address Line 2 City State ZIP Code

Membership Level & Payment

Choose you membership and submit payment.

Type of Membership(Required)

Individual Membership: Total: $325.00 (Membership: $225 +$100 One-time initiation fee)

Corporate Membership (2 Members): Total: $425.00 (Membership: $325 +$100 One-time initiation fee)

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.