Become a Member

Annual Membership Level:

Associate $30.00 ( Only with proof of ID: Students, Veterans & Senior Citizens 65+)

Active Professional $50.00

Active Business $75.00

Corporate II : fewer than 50 employees $100.00

Corporate I : 50 or more employees $250.00

Make check payable to : GFWHCC Mail to 200 E Main St #800, Fort Wayne, IN 46802

MEMBERSHIP APPLICATION

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Date

Please check one

• Active Business Employees
• Corporate I: 50 or more employees
• Corporate II: fewer than 50
• Active Professional
• Associate(Proof with ID : Students, US Veterans, Senior Citizens 65+)

COMPANY NAME

ATTN

ADDRESS

CITY

STATE

ZIP

BUSINESS PHONE

WEBSITE

EMAIL *

Email

Confirm Email

CONTACTS

MEMBER NAME

ADDRESS

CITY

STATE

ZIP

HOME PHONE

WEBSITE

E-MAIL *

Email

Confirm Email

PLACE OF EMPLOYMENT

CITY

STATE

ZIP

Please indicate how you would like to receive information :

• E-MAIL
• FAX
• U.S MAIL

Check enclosed for $

YOUR BUSINESS SHOULD BE LISTED UNDER THE FOLLOWING CATEGORIES (Please select maximum of two that closely apply)

• Accounting
• Advertising/ Marketing
• Architects
• Attorney / Law Firms/ Legal Resources
• Auto Manufacturing/ Distribution
• Banks, Credit Unions & Lending
• Business Consulting
• Cleaning Services
• Communication Management
• Computers/ Computer Services
• Education
• Employee Benefits
• Equipment
• Export
• Financial Services
• Food Manufacturing/ Distribution
• General Members ( No Business)
• Government
• Grocery Stores/ Supermarket
• Healthcare
• Heating & Air Conditioning
• Human Resources
• Insurance
• Investigations
• Manufacturing ( Non-Food)
• Media/ Publishing
• Non -for-profit
• Personal Care ( example – beauty salon)
• Real Estate & Read Estate Services
• Restaurants
• Retail
• Retirement Plans
• Stock Brokers
• Translation Services
• Utilities

Others

Briefly describe your business :

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