INVESTOR LOGIN T 260 420-6945

Member Application

Welcome and thank you for applying for membership with Greater Fort Wayne Inc. All membership applications are subject to approval.

For additional information or to discuss investor benefits for the Leadership Alumni Association, Women's Network, or Bridge Program, please contact Investor Services at 260-203-5765.

IMPORTANT NOTE: Your application must be completed in its entirety in order to be processed. Incomplete applications will not be saved.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website: *

Email: *

Business Description (200 char max): *

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words): *

Comments / Questions:

Referred By:

Date Company Established: *

Underrepresented minority-owned business:

Woman-owned business:

Veteran-owned business:

Is your company less than three years old?: *

Is your company a sole proprietorship?: *

Is your company a nonprofit organization?: *

Is your company a member of another chamber of commerce?: *

If yes, which?:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Social Networking:

LinkedIn Facebook Instagram Twitter

Primary Contact Information

First Name: *

Last Name: *

Title: *

Phone: *

Cell Phone:

Email: *

Contact Preference:

Email Phone

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title: *

Phone: *

Cell Phone:

Email: *

Contact Preference:

Email Phone

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Investment Level 1: $400.00
2-10 Employees Investment Level 2: $600.00
11 -20 Employees Investment Level 3: $800.00
21-50 Employees Investment Level 4: $1,000.00
51-100 Employees Investment Level 5: $2,500.00
101-150 Employees Investment Level 6: $5,000.00
151+ employees Sole Proprietor Discount: $250.00
New Business Discount: $200.00
Investment Level 1 - 20% Discount: $320.00
2-10 Employees Investment Level 2 - 20% Discount: $480.00
11-20 Employees Investment Level 3 - Discount: $640.00
21-50 Employees

Additional Opportunities:

We will contact you with additional information.

KPC Business Weekly: $0 : $0.00
I do wish to receive a free subscription to the Greater Fort Wayne Business Weekly paper, (valued at $52) and a free copy of the annual "Book of Lists" (valued at $49.)

Payment Option:

Bill me Charge my credit or debit card

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200 E. Main Street, Suite 800
Fort Wayne, IN 46802 | 260 420-6945
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