Membership Application

Membership Status(Required)

Membership Type(Required)

Contact Information

Primary Contact Name(Required)

This name will appear on your membership card.

Primary Contact Email(Required)

Secondary Contact Name

Secondary Contact Email

Business Name

This will appear on your membership card.

Phone

Phone Type

Website

Tell us about yourself or your business.

Physical Address

Street Address Address Line 2 City State ZIP Code

Mailing Address

Mailing address is the same as physical address.

Mailing Address

Street Address Address Line 2 City State ZIP Code

Membership Options

I do NOT want my contact information made available to other members.

I would like to offer discounts for my products or services to members.

My business is open to the public on First Fridays.

Preferred Payment Method

Upon completion of this form, you will be contacted by a CCA representative to arrange payment. Annual dues renew every 12 months after application is processed.

Membership dues are not deductible as a charitable contribution for federal tax purposes. Individual Contributors may be able to deduct for federal tax purposes a certain percentage of their contribution as a business expense, but each contributor should consult with their tax planning experts to determine if they may take such a deduction. 5% of CCA’s revenue may go toward lobbying activity.

I consent to becoming a Member or a Friend of the Crossroads Community Association. If the Member applicant is an entity, the designated representative, by submitting this Application on the entity’s behalf, certifies that the entity is duly organized and in good standing in its State of organization, and is duly authorized to transact business within the Crossroads District.

Consent(Required)

I agree to the above statement.

Security

Name

This field is for validation purposes and should be left unchanged.