: VLCT

Add Organization Basic Information
Add Organization Contact Information
Add Primary Contact
Add Alternate Contact
Membership & Add-ons
Review Totals

Organization Basic Information

Organization Name

Business Alliance Program Level

Business Category

Parent Organization Name

Website

https://

Description of Product or Service

Maximum 255 characters.

Booth Choices

Booth Choice 1

Booth Choice 2

Booth Choice 3

Organization Contact Information

Address

Address Cont.

City

State

Zip Code

Country

Phone Number

Fax Number

Primary Contact

Username

Password

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

Confirm Password

Add Yourself as Primary Contact

First Name

Last Name

Job Title

Copy primary contact 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

Alternate Contact (Optional)

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 contact 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 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

Primary Contact

Alternate Contact (Optional)

Membership & Add-ons

Totals

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

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