Application

Please complete the form below. If you have any questions, please contact Andrea Medved at 414-287-4115.

Organization Information Will be displayed online

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State

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Fax Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Website Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Email Required Please enter a valid number Please enter a valid date Please enter valid credit card information Must be a valid email address

Headquarters Location (if outside Metro Milwaukee) Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Number of Metro Milwaukee Employees Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Number of Total Employees

Does your business fall under any of these categories? (Please select all that apply by clicking while holding Ctrl Key)

MMAC Primary Contact This person will be listed in the MMAC membership directory and will receive email notifications. Please note, emails are not published.

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Last Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Title Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Direct Phone Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Direct Email Required Please enter a valid number Please enter a valid date Please enter valid credit card information Must be a valid email address

Contact Address is Same as Above

Yes

Address 1 Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Address 2 Required Please enter a valid number Please enter a valid date Please enter valid credit card information

City Required Please enter a valid number Please enter a valid date Please enter valid credit card information

State

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Additional Contacts

Take full advantage of your membership - add contact information for your employees who can benefit from MMAC programs and services (ie. top executives, sales, finance, human resources, marketing, information technology, and other key areas within your company).

Contact 1

First Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Last Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Title Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Email Address Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Contact 2

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Last Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Title Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Email Address Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Contact 3

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Title Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Email Address Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Contact 4

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Last Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Title Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Email Address Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Contact 5

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Last Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Title Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Email Address Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Contact 6

First Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Last Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Title Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Email Address Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Contact 7

First Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Last Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Title Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Email Address Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Contact 8

First Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Last Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Title Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Email Address Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Contact 9

First Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Last Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Title Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Email Address Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Contact 10

First Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Last Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Title Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Email Address Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Billing Address

Billing Address is Same as Above

Yes

Billing Contact First Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Biling Contact Last Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Address 1 Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Address 2 Required Please enter a valid number Please enter a valid date Please enter valid credit card information

City Required Please enter a valid number Please enter a valid date Please enter valid credit card information

State

Zip Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Mailing Address

Mailing Address is Same as Above

Yes

Address 1 Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Address 2 Required Please enter a valid number Please enter a valid date Please enter valid credit card information

City Required Please enter a valid number Please enter a valid date Please enter valid credit card information

State

Zip Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Business Category

Primary Business Category (for printed and online directores)

Additional Business Categores (listed only in online directory, max 5) Select additional directory categories below by holding the "CTRL" key. Secondary categories may be subject to additional fees.

Areas of Interest Check all that apply. **Additional Fees Required

Main Reason for Joining Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Networks & Services

Executive roundtable program (for CEOs, Pres., Owners/Senior level exec./sales management/top financial exec.)
Roundtables for high-growth companies (CEOs of Growing Businesses**)
International/exporting (World Trade Association**)
Young professionals/talent attraction (FUEL Milwaukee**)
Food & beverage manufacturers industry cluster (FaB Wisconsin**)
Office Depot discount program
Certificates of origin

Promote my Business

Business networking events
Advertising opportunities/sponsorships**
Offering discounts to members
Business referral groups**
Member mailing lists**

Advocacy

Public Policy Agenda
Access to MMAC lobbyists
Access to local, state and federal legislators
Political contributions (PAC/Conduit)**
Improving K-12 education

Economic Development

Developing the talent pipeline
Minority supplier network
Regional economic development/M7

Comments/Questions Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Payment

Membership Type

Annual Membership Investment

Total

Enhanced Membership ($50)

Additional Categories Cost

One-Time Application Fee

Tax

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Number of Part Time Employees

Number of Rooms

Number of Seats

Number of Associates

Number of Locations

Millions in Assets

Referred By Required Please enter a valid number Please enter a valid date Please enter valid credit card information

How did you hear about us? Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Full-Time Employees Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Part-Time Employees Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Hotel/Motel Rooms Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Restaurant Seats Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Additional Associates Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Additional Associates Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Additional Locations Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Additional Locations Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Assets Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Assets Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Additional Categories Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Number Of Additional Categories Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Additional Categories Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Additional Item 1 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Additional Item 2 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Additional Item 3 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information

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Additional Item 8 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Additional Item 9 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Additional Item 10 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Annual Dues (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Revenue Item Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Tax (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Fee (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information

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Payment Type

NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.

Credit Card Type

Mastercard

Visa

Discover

Amex

Credit Card Number Required Please enter a valid number Please enter a valid date Please enter valid credit card information

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Credit Card Email Address

I hereby authorize and consent permission for MMAC to use information provided on this application to be published in our newsletter, website and Directory. I authorize MMAC and their sponsors to mail, e-mail or fax me information.

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