Membership Application

I've reviewed the Membership Level explanations and I'm ready. Sign me up as a WayNet Member!

Please provide the following contact information:
(Fields marked * are required)

Membership Name will be listed as:		*
URL:
First name:		*
Last name:		*
Title:
Organization (if applicable):
Street address:		*
Address (cont.):
City:
State/Province:
Zip/Postal code:		*
Work Phone:
Home Phone:
FAX:
Contact's E-mail:		*
If applicable...
Facebook:
Twitter:

Membership level dictates the amount of exposure your link receives on the WayNet site.
Choose a membership level, please:

        Please select one of these options: Platinum - $2500/year Gold - $1000/year Sponsoring - $500/year Commerce Package - $400/year Business - $25/month Not-For-Profit - $5/month Basic - $5/month Other Services - Please Contact Me

Sponsors are billed on an annual basis; if you are signing up for a Basic or Business Membership, you may indicate if you prefer to be billed
        Annually  or Quarterly

May we send you WayNet News, a low-volume e-newsletter used to communicate with our members and others interested in Wayne County, Indiana? 

        Yes!  Please do.  No, I don't want to know what's happening with WayNet and Wayne County.

By submitting this form, you agree to pay the membership fee as described above.  You understand that non-payment of these fees will result in the removal of your link(s) from the WayNet.org web site.  You also agree that you have read and consent to abide by WayNet's Terms of Service.