All fields marked with (*) are required

Organization Information

Organization Name:*

First Name:*

Last Name:*

Main Phone:*

Toll Free:

Website:

Physical Address

Street:*

City:*

State:*

Zip:*

Check if billing address is the same as physical address

Billing Address (if different)

Street:

City:

State:

Zip:

Demographics

Nature of Business:*

Type of Employer:*

Industry Classification:*

Employee Count:*

NAICS Code :

Code Lookup

Total Employee Count:*

Reason for joining:

In what states do you operate?

Contacts

Please provide contact information for individuals in your organization. One Primary Contact and one Census Contact are required

Add new contact

Contact Type

Name

Title

Phone

Grant

Government Contracts

Government Contracts in excess of $50,000

Yes No

Union

Do you have a union?*

Yes No

Add Union

Union Name

Local Number

City

State

Dues

Application Type:*

Dues Amount:*

Dues Calculator

Terms & Conditions

I Agree to the terms and conditions.*

How did you hear about Employers Council:*

Applicant’s Email:*

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