Membership Form "*" indicates required fields Annual Partnership Dues and add-onsMembership Options* No employees - Sole proprietor - $60.00 1-10 Employees - $120.00 11-20 employees - $240.00 21-50 employees - $360.00 51-100 employees - $480.00 100+ employees - $600.00 Tribal Nation - $250.00 Econ Development Orgs - $100.00 Partners from outside Pacific County - $250.00 Community Non Profit - $50.00 Community individual Supporter - $50.00 * Scholarships are available for businesses with less than 20 employees, if cost is an issue. Click here to access the scholarship application: https://www.cognitoforms.com/PCEDC1/pcedcmembershipscholarshipapplication Your Success is our success!Pacific County Economic Development Council (PCEDC) is a county-wide economic development partnership whose goals are aligned to create a dynamic and well-developed economy in Pacific County. Join us in building successful businesses and thriving communities!Have you ever been a member of PCEDC in the past? Yes. No. Not Sure. Your information will not be shared or sold. Contact membership@pacificcountyedc.org at any time with questions or suggestions. Contact InformationBusiness NameUBI # (if none - enter 0)Owner/ Executive Name* First Last Who is filling out this form?* First Last contact information of who is filling out the membership formBusiness Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Website or FB Page Enter either or both.Website or FB Page What is your ethnicity?*Please SelectWhiteBlack or African AmericanAmerican Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderI prefer not to answerDo you employees work from a physical building or do your employees work online?*Please SelectPhysical buildingOnline onlyHybrid - both physical & onlineHow many employees?*Business Sector*Please SelectMarine/SeafoodAgricultureForestryEducationTechnologyConstruction/TradeEntertainmentLodgingRestaurantRetailRecreationManufacturingHealthcarePublic ServiceNonprofit OrganizationOtherOther (Please Specify)Total Credit CardCard Details Cardholder Name CAPTCHA
