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Organization/Company Name *

Type *

(Type of business, chamber, nonprofit, econ. dev., community org., etc)

Primary Contact's Name *

Email Address *

Mailing Address *

Physical Address

City *

State *

Zip Code *

Business Phone *

Cell Phone

What are your primary interests in the SPUCC organization? For example, one or more of the initiatives of Community Development, Tourism, or Legislation. Or any other specific areas of interest you have? *

Fax

List names and emails of others in your organization who should be added to the SPUCC email list:

Verification

If you are human, leave this field blank.

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