Business Description

Please provide a brief description of your business:

Logo (please upload your logo)

Please select two (2) categories for your business to be listed in

Other (please write category type)

Service Areas

Do you add a travel fee to travel out of your registered area?

Yes

No

Would you be interested in participating in the Multiple Booking Discount Program? This program offers customers a 10% discount if they book three or more participating vendors for one event.

Yes

No

Membership Options

Monthly Membership

$40 per month

$55 per month (includes conference room privileges)

Annual Membership

$420 per year

$600 per year (includes conference room privileges)

Early Sign-Up Discount ($35/50) for the first 3 months if you sign up BEFORE September 25, 2024

Yes

No

Payment Information

DO NOT FILL IN YOUR CARD INFORMATION! We will collect this AFTER we contact you, these fields are for our office use only. You will NOT be billed at your application submission. We will contact you BEFORE charging your card.

Billing Address (if different from business address)

Payment Method

Credit Card

Debit Card

Cardholder Name:

Card Number (for office use only)

Expiration Date (for office use only)

CVV (for office use only)

Zip Code (for office use only)

Additional Information

How did you hear about Magic Valley Mobile Connection?

Terms and Conditions

By submitting this form, you agree to abide by the rules and regulations of Magic Valley Mobile Connection.

Membership fees are non-refundable.

By submitting this form, you agree to be contacted by Magic Valley Mobile Connection to complete payment for membership.

Signature

Signature field is empty.

FOR OFFICE USE ONLY

Membership Start Date:

Member ID:

Payment Received

Yes

No

Logo Received

Yes

No