Company Name * Contact Person Address * City * State * AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip * Email * Phone * Fax Website URL Description of Business * Business Logo Please upload your business logo. Your logo should be min. 450px width X 300px height.Files must be less than 2 MB.Allowed file types: jpg jpeg png. Membership Type (Click on appropriate button) * Financial Institution - $500/year Out of Parish (no physical presence in Pointe Coupee Parish) - $200/year Individuals/Non-Profits -(Individuals, Retirees, Public Officials, Non-Profit/Civic Organizations, Schools, Churches) - $100/year Business (Non-Financial) - $125.00 Business Size * 0-4 Employees - $125 5-9 Employees - $150 10-19 Employees - $200 20-49 Employees - $300 50-74 Employees - $500 75-99 Employees - $600 100-149 Employees - $800 150-199 Employees - $1,100 200-299 Employees - $1,600 300-399 Employees - $2,200 400+ Employees - $2,750
