Membership Application

Please complete the following or download an application here.
* indicates required field

About You

First Name*

Last Name*

Email*

Title*

Company*

Years/Months in current position:

Company Information

Business Address*

Address Line 2

City*

State*

Zip Code*

Telephone Number*

Web Address

Describe your product or service:

To Whom Do You Report?

Supervisor Name:

Title:

Phone:

Type of Membership:*

Individual Membership ($170.00)Individual Non-profit 501(c)(3)** - ($85.00) for one member (please attach certification of your 501(c)(3) status)Corporate Membership - includes all company employees ($450.00)

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Additional Memberships ($60.00/each member):

Please list additional individuals (Name, Title, Phone, Email):

Would you like a link to your company web site from CNYSME web site?*
YesNo

Please provide your logo so we have it on file.
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