Member Information Form

Member Information Form

Please complete this form so we can welcome you properly, promote your business, and connect you with relevant opportunities at NJCACC.
Personal Details
Full Name*

First NameLast Name
Preferred Name
E-mail*
example@example.com
Business Details
Business/Company Name*
Your Title*
Number of employees*

Sole proprietor1–56–2021–5050+Other
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Brief Business Description (2–3 sentences about what you do and who you serve; this may be used for member spotlights)
Engagement & Needs
Membership Type (select one)*

Individual Membership - AnnualIndividual Membership - LifetimeIndividual Membership - StudentCorporate Membership - BronzeCorporate Membership - SilverCorporate Membership - GoldCorporate Membership - SapphireCorporate Membership - Diamond
Why are you joining NJCACC? (select all that apply)*

NetworkingBusiness PromotionCommunity EngagementAccess to ResourcesAdvocacyProfessional DevelopmentHost a Chamber EventAdvertising OpportunitiesEvent Sponsorships OpportunitiesDiscount On Chamber EventsOther
What types of events are you most interested in? (select all that apply)*

Networking MixersEducational WorkshopsBusiness AdvocacyCultural EventsSmall Business ResourcesYoung Professionals Events
How did you hear about us?*

ReferralBoard MemberEventSocial MediaWebsite/SearchNewsletterOther
Anything else we should know about you or your business?
Should be Empty: