Member Application

Hello applicant. Please fill out the following application completely to ensure accuracy. Membership will be accepted once the following items are received/completed: 1. Application 2. License Verification, if applicable 3. Certificate of Insurance, please email or fax to Christina Reed 4. Dues Payment - must be paid: IN FULL $615 ----NOW - 11/30/21 $515----, 1st QUARTERLY $153.75, or 1st MONTHLY $51.25. Please select the 'Bill Me' option for quarterly or monthly. If you have any questions, please feel free to contact : Christina Reed | Director of Member Services, HBA of Western Michigan, 5700 West Michigan Avenue | Kalamazoo, MI 49009, phone: (269) 375-4225 | fax: (269) 375-6493 | email: christinar@hbawmi.com

Step 1:

Member Info
Please add your company name.
Please add your company phone number.
Please add a valid email.
Physical Address
Please add your address.
Please add your country.
Please add your City.
Please add your State.
Please add your Postal Code.
Mailing Address
Social Network Addresses

Step 2:

Additional Info
Please add your business keywords.
Please select a directory category.
Looks good!

Step 3:

Primary Contact
Please add your first name.
Please add your last name.
Please add your phone number.
Please add a valid email.

Contact Preference

Address
Please add your address.
Please add your country.
Please add your City.
Please add your State.
Please add your Postal Code.
Social Network Addresses
Create Account
Please add your login password.

Step 4:

Billing Contact
Please add your first name.
Please add your last name.
Please add your phone number.
Please add a valid email.

Contact Preference

Address
Please add your address.
Please add your country.
Please add your City.
Please add your State.
Please add your Postal Code.
Social Network Addresses
Create Account
Please add your login password.

Step 5:

Membership Package
Please select a Membership Package
Additional Options:
Payment Option
Please complete the Captcha
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