Member Application Business Information Company Name: * Leave Blank: Phone: * Website: * Email: * Directory Category: * --- Select Primary Category --- Business Community Cities County Education Government Individuals Non-Profits Other Government State Utilities How did you hear about WESTMARC?: * Business Referral Media Other If you were referred to WESTMARC, who referred you?: * Physical Address Line 1: * Line 2: City: * State: * Postal Code: * Country: * --- Select Country --- Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bermuda Bolivarian Republic of Venezuela Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo [DRC] Costa Rica Croatia Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Greece Greenland Guatemala Haiti Honduras Hong Kong Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Lao PDR Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Macedonia (Former Yugoslav Republic of Macedonia) Malaysia Maldives Mali Malta Mexico Moldova Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Principality of Monaco Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Serbia and Montenegro (Former) Singapore Slovakia Slovenia Somalia South Africa Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad and Tobago Tunisia Turkey Turkmenistan U.A.E. Ukraine United Kingdom United States Uruguay Uzbekistan Vietnam Yemen Primary Contact Information First Name: * Last Name: * Phone: * Email: * Contact Preference: Email Phone Login: * Password: * Address Same as Member Address Line 1: * Line 2 City: * State: * Postal Code: * Country: * --- Select Country --- Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bermuda Bolivarian Republic of Venezuela Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo [DRC] Costa Rica Croatia Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Greece Greenland Guatemala Haiti Honduras Hong Kong Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Lao PDR Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Macedonia (Former Yugoslav Republic of Macedonia) Malaysia Maldives Mali Malta Mexico Moldova Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Principality of Monaco Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Serbia and Montenegro (Former) Singapore Slovakia Slovenia Somalia South Africa Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad and Tobago Tunisia Turkey Turkmenistan U.A.E. Ukraine United Kingdom United States Uruguay Uzbekistan Vietnam Yemen Billing Contact Information Same as Primary Contact First Name: * Last Name: * Phone: * Email: * Contact Preference: Email Phone Login: * Password: * Address Same as Member Address Line 1: * Line 2 City: * State: * Postal Code: * Country: * --- Select Country --- Canada United States Membership Options Membership Package: * Chairman's Circle: $20,000.00 Please select the committees that your company would like representation on. We will reach out to you for contact information for those representatives. Premier Partner: $15,000.00 Please select the committees that your company would like representation on. We will reach out to you for contact information for those representatives. Platinum: $10,000.00 Please select the committees that your company would like representation on. We will reach out to you for contact information for those representatives. Gold: $6,000.00 Please select three committees that your company would like representation on. We will reach out to you for contact information for those representatives. Silver: $3,000.00 Please select two committees that your company would like representation on. We will reach out to you for contact information for those representatives. Bronze: $1,500.00 Please select one committee that your company would like representation on. We will reach out to you for contact information for those representatives. Copper: Please contact us to determine the fee. This level is restricted to K-12 school districts. If you are a non-profit organization, please contact shoffman@westmarc.org. *Please note that by selecting this level you are not automatically placed into this member category. Approval from WESTMARC President & CEO is required. Please select one committee to participate on. Additional Opportunities: We will contact you with additional information. Economic Development Committee : $0.00 The Economic Development Committee meets bi-monthly on the 3rd Thursday, 8:30-10:00 am Education & Workforce Development Committee : $0.00 The Education & Workforce Development Committee meets bi-monthly on the 2nd Wednesday, 7:30-9:00 am Healthcare Committee : $0.00 The Healthcare Committee meets bi-monthly on the 3rd Tuesday, 8:00-9:30 am Public Affairs Committee : $0.00 The Public Affairs Committee meets monthly on the 1st Monday, 8:30-9:30 am but does not meet July-September Infrastructure Committee : $0.00 The Transportation Committee meets Bi-Monthly - 4th Wednesday, 2:00 - 3:30 p.m. Payment Option: Bill me Charge my credit or debit card Please scroll down to view the entire policy and then click Accept. Decline I have read and accept the privacy policy of WESTMARC. I grant WESTMARC permission to contact me regarding my account, news, updates, and offers. Please read and accept the privacy policy before continuing. Print Application
