Membership Application Rising Tides Alliance is looking for the most powerful networkers in the Westchester County Area. We are opening up our membership and looking for businesses that are located in or service the Mid-Westchester Area. To join RTA complete the following application and purchase your annual membership below.Required Business InformationName* First Last Email* Business Name* Business Type / Industry* Office Phone*Mobile Phone*Business Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code What is your mail goal of joining RTA?*What categories do you currently have business relationships with and who are they?*What business relationships would you like to see more of?*Who referred you to RTA?* What panel topics interest you?*Are you currently working with any non-profit organizations? If so, which one(s)?*HeadshotPlease upload a professional headshot or photo to be featured in your public website profileAccepted file types: jpg, jpeg, gif, png, webp, Max. file size: 10 MB.Optional Personal InformationThe information below is not mandatory; however, we would like to get you know you better.Home Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Birthday MM slash DD slash YYYY Marital StatusSingleMarriedDivorced or SeparatedHobbies and Community InterestsDo you have any children? Yes No Number of childrenChildren's ages Payment InformationAnnual membership for RTA is $240. Lunch meetings are $25 prepaid online or $30 at the door.RTA Annual Membership* Price: Optionally pre-pay for up to 12 lunch meetings Quantity Price: $30.00 Quantity Total $0.00 Credit Card* DiscoverMasterCardVisaSupported Credit Cards: Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Credit card billing address* My credit card bills are sent to the business address filled out above Please allow me to specify a different billing address Credit Card Billing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Δ
