2021 Membership Application Form

2021 Membership Application

To apply for membership, please complete all questions.
Name *

First Name Last Name
Business Name *
Business Phone Number for Publication *

Area Code Phone Number
Secondary Phone Number for Business Contact

Area Code Phone Number
E-mail *
E-mail address for publication in the Directory
Business Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Website
Business Hours (if applicable)
Description of your business for the Directory
Please upload an image or logo to represent your business (for the Directory)
Enter the message as it's shown *
Membership Type *
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Organizational Membership $ 240.00
Pay by PayPal, MasterCard, Visa, AmEx, Discover.

Organizational Membership - Sliding Scale $ 180.00
By choosing this sliding scale option, I certify that my business has suffered due to the COVID-19 pandemic and I require assistance with affording my membership this year.

Monthly Payments $ 40.00
By choosing this, I agree to be invoiced $20 per month beginning March 1 to total $240 for the year. The first payment is $40 to cover January and February.

Paying by check (please make payable to Glens Falls Collaborative and mail to: P.O. Box 825, Glens Falls, NY 12801) Free
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