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Micronet template

Member Application

As a member, you receive the support and mentorship from dedicated professionals in both the private and public sector. You’ll receive preferred pricing to all our events, free admittance to our exclusive networking events and much much more.

Step 1: Member Info

Step 2: Additional Info

Step 3: Primary Contact

Step 4: Billing Contact

Step 5: Membership Options

Step 1:

Member Info

Company Name *

Please add your company name.

Leave Blank

Phone *

Please add your company phone number.

Website

Email *

Please add a valid email.

Physical Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

State *

Please add your State.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Mailing Address

Same as physical address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

State *

Please add your State.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Social Network Addresses

LinkedIn

Facebook

Step 2:

Additional Info

Business Description (200 char max) *

Please add your company description.

Business Keywords * (enter a space between words)

Please add your business keywords.

Directory Category *

Please select a directory category.

Full-time Employees *

Please add your number of full-time employees.

Part-time Employees *

Please add your number of part-time employees.

Do you have any business certification? Which ones? *

Looks good!

NAICS Code

Would you like to enroll on Auto Pay? (If yes, please save your Credit card upon checkout)

Step 3:

Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title

Phone *

Please add your phone number.

Cell Phone

Fax

Email *

Please add a valid email.

Contact Preference

Email

Phone

Address

Same as Address in Step 1

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

State *

Please add your State.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Social Network Addresses

LinkedIn

Facebook

Create Account

This Login is already in use

Login *

Please add your login username.

Password *

Please add your login password.

Step 4:

Billing Contact

Same as Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title

Phone *

Please add your phone number.

Cell Phone

Fax

Email *

Please add a valid email.

Contact Preference

Email

Phone

Address

Same as Primary Contact Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

State *

Please add your State.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Social Network Addresses

LinkedIn

Facebook

Create Account

This Login is already in use

Login *

Please add your login username.

Password *

Please add your login password.

Step 5:

Membership Package

Please select a Membership Package

Student Membership $25

Individual Membership $100

0-10 Employees $250

SBE/WBE/MBE/DBE/VOSBE Business Firms, Not-For-Profit Organizations, Government Institutions

11-50 Employees $500

SBE/WBE/MBE/DBE/VOSBE Business Firms, Not-For-Profit Organizations, Government Institutions

51+ Employees $1,000

SBE/WBE/MBE/DBE/VOSBE Business Firms, Not-For-Profit Organizations, Government Institutions

0-10 Employees Business Firm $300

11-50 Employees Business Firm $600

51+ Employees Business Firm $1,200

Corporate Partner $3,000

Sustaining Corporate Partner $5,000

Comments/Questions

Payment Option

Charge my credit or debit card

Please complete the Captcha

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Our mission is to promote the continued growth and development of New Jersey businesses.

EIN: 22-3121532

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Contact Information

1 Orient Way, Suite F, Box 290 Rutherford NJ 07070

(201) 935-0035

[email protected]

Office Hours: 9:00 AM - 5 PM

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