Member Application

Thank you for your interest in the Plexus LGBT & Allied Chamber of Commerce.

By completing and submitting the Membership Application you authorize the Chamber to:

• publish your name, photo and/or business information in the Chamber’s newsletter, online directory and other publications
• understand that the Chamber will use your email address for sending general communications and invoices
• Membership Applications are subject to administrative and/or Board approval.

A Member’s renewal date is 12 months from the month the member joins. Paid dues are non-refundable.
If you have any questions, please contact us at info@thinkplexus.org or 216-243-7510.

PLEASE NOTE: If joining as a Retiree, Young Professional or Professional Member place your name in the Company name field.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max):

Directory Category:

Business Keywords (enter a space between words):

Comments / Questions:

If you are a private business, what percentage of your business is LGBTQ owned?:

How do you as the primary contact identify?: *

Does your company have an LGBTQ Employee Resource Group (ERG)?:

If relevant what is your LGBTQ ERG name?:

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 YouTube

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook Instagram YouTube

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: *

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook Instagram YouTube

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Print Application