Online Membership Registration – Medina Area Partnership

Online Application

Online Payment Only

Business Information

Legal Name of Business *

Trade Name *

Date Established

Ex: 01/01/2022

Website / URL

Facebook

Instagram

Brief Description of Business

Business Location

Address *

Address Line 1

City

State

Zip Code

Phone

Business Contact Information

Primary Contact

Primary Name *

First

Last

Phone

Primary Email *

Date of Birth

Ex: 01/01/2022

Secondary Contact

Secondary Name

First

Last

Phone

Secondary Email

Secondary Date of Birth

Ex: 01/01/2022

Accounts Payable Contact (if different from above)

AP Name

First

Last

Membership Selection

Partnership:
Operating within 14103, membership listing on website, participation in MAP events at no additional fee, participation in MAP activities at a reduced fee, serve and chair committees, serve on the Board of Directors, vote at general meetings.

Associate:
Operating within 14103, membership listing on website, participation in MAP events for an additional fee, participation in MAP activities at an increased fee, serve and chair committees, serve on the Board of Directors, vote at general meetings.

Affiliate:
Located outside 14103 with a vested interest in the success and continual progress of Medina, membership listing on the website, participation in MAP activities at an increased fee, serve on committees.

Membership Level *

Partnership - $ 100.00
Associate - $ 50.00
Affiliate - $ 25.00

A convenience will be added to the final total.

Total

$0.00

Checkboxes *

By submitting this form, I agree to the following:

All information provided on this form is up-to-date and accurate. Membership will not be approved until payment is received, for problems, please send your request via the contact form on this website. All dues are calendar year.