: VLCT

Add Organization Basic Information
Add Organization Contact Information
Add Billing/Administrative Contact
Add Published Contact/Prime
Membership & Add-ons
Review Totals

NOTE: Membership levels can only be changed on the first page of the form!

Organization Basic Information

Organization Name

Business Alliance Program Level

Business Category

Parent Organization Name

Website

https://

Description of Product or Service

Maximum 255 characters.

Organization Contact Information

Address

Address Cont.

City

State

Zip Code

Country

Phone Number

Fax Number

Billing/Administrative Contact

Username

Password

14 character minimum and one of each of the following: Uppercase, lowercase, numbers, and special characters.

Confirm Password

Add Yourself as Billing/Administrative Contact

First Name

Last Name

Job Title

Copy address from your Organization Contact Information

Mailing Address

Mailing Address Cont.

City

State/Province

Zip/Postal Code

Country

Work Phone

Work Extension

Fax

Cell Phone

Home Phone

Email Address

Published Contact/Prime

If your billing contact is the same as your primary contact you do not need to fill out this section.
Suggested username format is FirstnameLastname.
New users entered here will be prompted to change their passwords the first time they login.

Username

Password

14 character minimum and one of each of the following: Uppercase, lowercase, numbers, and special characters.

Confirm Password

First Name

Last Name

Job Title

Copy address from your Organization Contact Information

Mailing Address

Mailing Address Cont.

City

State/Province

Zip/Postal Code

Country

Work Phone

Work Extension

Fax

Cell Phone

Home Phone

Email Address

Contact Preference

Membership & Add-ons

Membership Dues

Membership Name	Amount
BAP Exhibitor Booth	$850.00
BAP Gold	$10000.00
BAP Nonprofit	$395.00
BAP Platinum	$20000.00
BAP Preferred	$595.00
BAP Standard	$495.00
BAP Tier 1	$5000.00
BAP Tier 2	$2500.00

Totals

Membership Dues:	$0.00
Discounts:	$0.00
Optional Subscriptions:	$0.00
Optional Donations:	$0.00
Optional Products:	$0.00
Taxes	$0.00
Credit Card Surcharge	$0.00
Total Payment:	$0.00

Payment Options

Select Payment Method

Accepted Card Types

Card Number

Expiration Date

Expiration Year

CCV

Save payment method for future use

Billing Information

Copy billing information from your user profile.

First Name

Last Name

Billing Address

City

State

Zip

Country

Terms and Conditions By submitting this form you are authorizing your credit card to be charged for the indicated amount. There are no refunds available. Please see our full terms and conditions page for further details. If you have any questions, please contact info@vlct.org at info@vlct.org or call (802) 229-9111. Thank you for choosing Vermont League of Cities and Towns.

Organization Basic Information

Organization Contact Information

Billing/Administrative Contact

Published Contact/Prime

Membership & Add-ons

Totals

There is a % surcharge on credit card transactions to cover merchant fees.

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