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Organization Information (to be displayed online) Contact First Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information Contact Last Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information Business/Organization Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information Business/Organization Type None Accounting Aerospace Agriculture Airport Management Architecture Artificial Intelligence Arts Attorneys/Legal Services Automotive AV Production & Web Design Banking/Finance Builders & Developers Catering Childcare Communications/Marketing/Advertising/Public Relations Construction Consulting Contractors Convention Services & Facilities Cybersecurity Education Employment Agency Energy Engineering Entertainment & Leisure Entrepreneur Environmental Event / Meeting Management Franchising Government Affairs / Public Affairs Government Contracting - Consulting Government Contracting - Defense Government Contracting - IT/Technology Government Contracting - Other Government Entities Health / Health Care Services Hotels & Event Venues Human Capital Management Human Resources HV/AC Information Technology Insurance Manufacturing Marketing Programs & Services Media Outlets / Broadcasting / Publications Mortgage Services National Security & International Affairs Non Profit / Association / Chamber Office / Business Services Other Plumbing Professional Development Professional Services Property Management Real Estate Relocation / Moving / Storage Relocation Services Research and Development Restaurants Retail Store & Services Security Software Development Telecommunications Tourism Transportation Travel Utilities Venture Capital Waste Management and Recycling Address 1 Required Please enter a valid number Please enter a valid date Please enter valid credit card information Address 2 Required Please enter a valid number Please enter a valid date Please enter valid credit card information City Required Please enter a valid number Please enter a valid date Please enter valid credit card information State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Required Please enter a valid number Please enter a valid date Please enter valid credit card information Phone Required Please enter a valid number Please enter a valid date Please enter valid credit card information Fax Required Please enter a valid number Please enter a valid date Please enter valid credit card information Website Required Please enter a valid number Please enter a valid date Please enter valid credit card information Email Required Please enter a valid number Please enter a valid date Please enter valid credit card information Must be a valid email address Comments Required Please enter a valid number Please enter a valid date Please enter valid credit card information Membership Investment Membership Type Select one... General Organization 501(c)3 Organization Hotel/Motel Additional Directory Categories Select additional directory categories below by holding the "CTRL" key Secondary categories may be subject to additional fees none Number of Full Time Employees Number of Part Time Employees Number of Rooms NOVABizPAC Contribution ($50) NOVABizPAC Contribution Annual Membership Investment Total The contents of this box are for testing purposes. This box will be removed when the form goes live. Additional Categories Cost Tax Number of Seats Number of Associates Number of Locations Millions in Assets Full-Time Employees Required Please enter a valid number Please enter a valid date Please enter valid credit card information Part-Time Employees Required Please enter a valid number Please enter a valid date Please enter valid credit card information Hotel/Motel Rooms Required Please enter a valid number Please enter a valid date Please enter valid credit card information Restaurant Seats Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Associates Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Associates Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Locations Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Locations Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Assets Required Please enter a valid number Please enter a valid date Please enter valid credit card information Assets Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Categories Required Please enter a valid number Please enter a valid date Please enter valid credit card information Number Of Additional Categories Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Categories Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information NovaBizPac Contribution Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 2 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 3 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 4 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 5 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 6 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 7 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 8 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 9 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 10 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Annual Dues (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information Revenue Item Required Please enter a valid number Please enter a valid date Please enter valid credit card information Tax (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information Fee (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information Temp Value For DropDown 1 Required Please enter a valid number Please enter a valid date Please enter valid credit card information MembershipType Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 2 Additional Item 3 Additional Item 4 Additional Item 5 Additional Item 6 Additional Item 7 Additional Item 8 Additional Item 9 Additional Item 10 Web Directory Fee Payment Type Credit Card Check NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks. Credit Card Information Copy from Organization Information Credit Card Type MastercardVisaAmex Credit Card Number Required Please enter a valid number Please enter a valid date Please enter valid credit card information Name on Card Required Security Code Required Valid Through 01 02 03 04 05 06 07 08 09 10 11 12 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 Address Required City Required State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Required Phone Required Credit Card Email Address Please click submit only one time. The transaction may take several seconds. Please select a membership type before submitting your application.