Member Application

Thank you for your interest in joining the Mid-America Gay & Lesbian Chamber of Commerce! You are just minutes away from completing your application to become a member of the MAGLCC. Please note that all applications are subject to board approval.

Business Information

Company Name: *

Phone: *

Directory Category: *

Employees:

Full-time Part-time

Comments / Questions:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1:

Line 2:

City:

State:

Postal Code:

Country:

Social Networking:

LinkedIn Facebook

Primary Contact Information

First Name: *

Last Name: *

Phone: *

Email: *

Contact Preference:

Email Phone

Password: *

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

In the effort to fight spam, please provide the answer to the following question.

What is the sum of 3 plus 4?: *

Print Application

Printed courtesy of maglcc.org/ – Contact the Mid-America Gay & Lesbian Chamber of Commerce for more information.
, Kansas City, MO 64171 – (816) 474-3558 – [email protected]