Join the GOA Regional Business Association


GOA Regional Business Association Membership Application

Organization Information (to be displayed online)
Organization Name *
Address 1 *
Address 2
City *
State *
Zip *
Phone *
Fax
Website
Email *
Business Description
(this will appear in the directory) *

Limited to 80 characters
Main Contact
First Name *
Last Name *
Title
Phone *
Email *
Additional Contacts
Additional Information
Referred by
How did you hear about us?
What is your reason for joining?
Please have someone contact me regarding
*Check all that apply
Business Resources
Networking
Political Advocacy
Education Programs
Marketing/PR Opportunities
Increase Sales
Special Events
  Other:
Membership Investment
Membership Type: *
Primary Directory Category *
Additional Directory Categories
  • Primary Directory listing is complimentary
  • Additional Directory listings are $35 each
**Hold CTRL on your keyboard to select multiple categories**
Number of Employees:  
Millions in Assets (Financial Institutions):  
   
$ 
Annual Membership Investment: $ 

The contents of this box are for testing purposes. This box will be removed when the form goes live.
Full-Time Employees
Part-Time Employees
Hotel/Motel Rooms
Restaurant Seats
Additional Associates
Additional Associates Cost
Additional Locations
Additional Locations Cost
Assets
Assets Cost
AdditionalCategories
Additional Categories Cost
NumberOfAdditionalCategories
additionalItem1Cost
Annual Dues (charged to card)
Tax (charged to card)
Fee (charged to card)
tempValueForDropDown1
Number of Part Time Employees:  
Number of Rooms (Accommodations):  
Number of Seats (Restaurants):  
Number of Associates (Realtors, Attorneys):  
Number of Locations ($35/add. location):  
Enhanced Membership ($50):
$ 
$ 
*
NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.
Credit Card Information
Credit Card Type *
Credit Card Number * 
Name On Card
Security Code
Valid Through
Credit Card Address 1
Credit Card City
Credit Card State
Credit Card Zip
Credit Card Phone Number
Please click submit only one time.  The transaction may take several seconds.

Join the Greater O'hare Area Business Alliance