Membership Application

Business Name:
*

Number of Employees: 
Full Time: *   Part Time: *


Contact Name: 
*

Title/Position: 
*

Address: 
*

City: 
*

State: 
*

Zip: 
*

Phone (1): 
*

Phone (2): 


FAX: 


E-Mail: 
*

Website: 


Billing/Mailing Address: 
(if different than above) 




        

Additional Contacts 

Name/Title: 


E-Mail: 


Name/Title: 


E-Mail: 



Business Category: 
*


Brief description
*

How did you learn about MACC?
If referred, please list person/business.






Primary Interests
(check all that apply):













                                 


ANNUAL INVESTMENT RATES
Membership in MACC becomes renewable on the first day of the anniversary month joined. Cancellation of membership must be received in writing.
Number of EmployeesOne Year
Membership Investment		Special Categories
1 — 2$225Restaurants:         $310
3 — 5$255Banks: 1 - 5        $635
6 — 10$310           6 - 15       $775
11 — 18$380         16 - 50       $820
19 — 30$455         51- 100    $1025
31 — 50$515Utilities: 1 - 5       $425
51 — 75$625            6 - 15      $495
More than 76+ call for rates          16 - 30      $635
Non-Profit 1 - 5   $125
Affiliate/Branch:   $100**
** Please call the office (412-856-0622) to complete your application.


     Additional Category Listings:     > $25 for each additional listing.



MEMBERSHIP INVESTMENT

Annual Investment $
Additional Category Listing ~ $25 each $
Application Fee $ 25
Total$

PAYMENT OPTION *





Automatically renew my annual membership with the above card
 cards

Billing Address:

Billing City: State:  Zip:

Card Number

Exp. Date: Month (MM) Year (YY)

Name on Card 

Membership investment may be tax deductible as an ordinary business expense. Membership investment is not considered a charitable contribution.