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 NEW! Dual Membership Option Yes - I want to join both organizations and receive a 25% discount. No - I am not interested at this time. Attention Tourism-based businesses! Interested in joining BOTH our Pacific County EDC and the Pacific County Tourism Bureau? It just got easier! Join both and save 25% on your annual dues for both organizations!Discount $0.00 * 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 Name UBI # (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 Other Payment Options Please invoice me An invoice will be sent to the business address on this form. If you have questions regarding payment, contact membership@pacificcountyedc.orgCAPTCHA
