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* Mandatory fields

Organization Contact Info

*Address 1
Address 2
Zip Plus Four
*Phone - Organization
Please enter in this format: (xxx) xxx-xxxx. Thanks!
Only use if not US

Individual Contact Info

*First Name
Middle Name
*Last Name
Phone - Direct Line
Please enter in this format: (xxx) xxx-xxxx. Thanks!

Organization Info

Company description (less than 200 words please)
Business Category
Please choose up to three categories.
Number of Employees
Annual Sales in Millions
Member-to-Member Discount
If you're interested in offering a discount to other VBSR members, please list your offer here and we'll help spread the word!
Interested in Learning About
Web address
Facebook URL
Twitter Handle
*I have read and agree to VBSR's mission.
Our mission is to foster a business ethic in Vermont that recognizes the opportunity and responsibility of the business community to set a high standard for protecting the natural, human, and economic environments of our citizens.

Additional Contact Info

Contact Title/Role
Contact Address 1
If same, leave blank
Contact Address 2
If same, leave blank
Contact City
Contact Zip
Contact Zip Plus Four

________ ________ _________ __________ _

*Member-to-Member Communications
Do you want to receive information from other members?
*Amount ($USD)

Security check

* Code
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This is a good spot to place your secondary navigation gadget, like Navigation links, or Secondary menu

Replace this text with your copyright information and address.

"Your name" is a 501(c)6 non-profit organization. Street Address, City, State 123456

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