Member Registration

Enter Your Update Code to Continue Where you Left Off

Note: Highlighted field = Appears on AWC website

General Information

*Business Name:

*Street Address 1:

Street Address 2:

*Zip:

*City:

*State:

*Office Phone:

*Company Website:

Primary Contact

*Name:

*Title:

*Email:

Cell Phone:

Secondary Contact

Name:

Title:

Email:

Cell Phone:

*Membership Categories (select up to 3)

About your Business

*Description of Business:

* Note: This is limited to 2000 characters

*How did you hear about AWC?:

*Company Revenues:

Company Logo

							Upload Logo(.png, .jpg, or .gif smaller than 500kb)
							
*Note: Reselection is needed if there are validation errors of any kind

No Logo Uploaded

Contact Profile Picture

							Upload Contact Profile Picture(.png, .jpg, or .gif smaller than 500kb)
							
*Note: Reselection is needed if there are validation errors of any kind

No Profile Picture Uploaded

Payment Information

Total Due	N/A
Annual Membership Fee	N/A
One-time Enrollment Fee	$50.00

Payment Method

Please enter your credit card information below

*Credit Card Number(numbers only)

*Expiration Date(MM/YYYY)
/
*Security Code(number on back of card)

If you have issues with your payment, please email admin@awcmn.org