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Membership Application
Questions may be directed to RBA's Member Services Department at (585) 244-1800. Thank you!

(Required fields labeled in bold)

Organization Information

Company:
Phone: (000-000-0000)
Phone Extension
Fax: (000-000-0000)
Street Address (No PO Box):
City/State/Zip:
County:
Website:
Type of Business (As listed in the Yellow Pages):
NAICS Code (Leave blank if unknown):

Personal Information

Name:
(name of applicant)
Title:
Phone: (000-000-0000)
Phone Extension
E-Mail:

Membership Directory Listings/Mailing Lists

Senior Executive

Copy from Personal Information:
Name
Phone (000-000-0000)
Phone Extension
Title
Fax (000-000-0000)
Email

Dues Contact (Person to receive dues information and billing)

Copy from Personal Information:
Name
Phone (000-000-0000)
Phone Extension
Title
Fax (000-000-0000)
Email

Key Human Resource Contact

Name
Phone (000-000-0000)
Phone Extension
Title
Fax (000-000-0000)
Email

Additional Human Resourse Contact

Name
Phone (000-000-0000)
Phone Extension
Title
Fax (000-000-0000)
Email

Sales/Marketing Contact

Name
Phone (000-000-0000)
Phone Extension
Title
Fax (000-000-0000)
Email

Membership Type Select:

Total Number of Local Employees

(In the Greater Rochester area - Monroe, Genesee, Livingston, Ontario, Orleans and Wayne counties)

Number of full-time employees (Employees working 1000 or more hours per year):
Number of part-time employees(Employees working less than 1000 hours per year):

This figure is used as a basis for determining dues and enables us to ensure fairness and consistency in our calculations. RBA dues formula equates two part-time employees to one full-time employee.

Total Number of World-Wide Employees Number of full-time employees (Employees working 1000 or more hours per year): Number of part-time employees: (Employees working less than 1000 hours per year)

Membership Financial Details Annual Investment:

Hispanic Business Association
(Annual Individual Membership: $25)

Small Business Council
(Annual Individual Membership: $100; Corporate Membership: $250)

Women's Council
(Annual Individual Membership: $100)

Total Affiliate Fee:

Enrollment Fee is $30, automatically added into the total fee.

Total (payable upon application):

Payment Method:

Credit Card Information

Select your brand of card:
Name as it appears on credit card:
Credit Card Number:
(0000-0000-0000-0000)
Expiration Date:
CID

Billing Address

Check if billing and shipping address is the same:
Street Address:
City/State/Zip:
Please bill to the attention of:
P.O. Number (RBA Members Only):

Confidentiality
As a Rochester Business Alliance (RBA) member, your organization may be eligible to participate in wage, salary, and employee benefit surveys and can take advantage of customized programs and services conducted by the RBA. Data submitted by members to the RBA is strictly confidential.

In an effort to communicate effectively, the RBA will periodically mail, fax, or e-mail information to specific employees of our member organizations. In this application, you have designated those individuals that should receive information about programs, services, or networking opportunities. Please notify these individuals that they may receive mailings, faxes, or e-mails from the RBA.

As a benefit of RBA membership, you may participate in the exchange of business information and receive assistance from our staff. All RBA information and assistance is intended for internal use within your organization only. RBA data and materials may not be resold, disseminated, or used as part of any external consulting or marketing activities without the express written permission of the RBA.

Your Membership Commitment
We, apply for membership in the RBA, a not for profit employer’s association, and will pay membership dues for its support as set forth. Our membership may be cancelled at any time upon written notice to the RBA, or by action of the RBA’s Board of Directors. We agree that we will honor all obligations incurred prior to canceling our membership. We understand that the RBA reserves the right to deny or cancel membership, without prior written notice, of any organization whose goals and purposes are in conflict with the interests of the RBA or its subsidiaries. By joining the RBA our organization agrees to support RBA programs and to make an annual membership investment at the rate established each year the the RBA Board of Directors. Annual dues are payable in advance and are not refundable, even in the event of resignation. Members more than three (3) months in arrears are considered deliquent.

Your Membership Agreement
By submitting this application, you, as an authorized representative of your organization, agree to keep all information acquired through your RBA membership, including directories and survey information, confidential. You agree that you and your business will not use RBA directories for direct marketing purposes. You agree that you and your business will not, at any time after the date hereof, disclose or provide to any person, corporation, partnership or other entity whatsoever, any of the information contained in the wage, salary, and employee benefit surveys or the information the RBA provides concerning them. If you must disclose the information to an independent contractor for business-related reasons, you will first notify the RBA and secure an agreement from the contractor to follow these confidentiality provisions, before disclosing the information. If your membership is dropped, you will return all copies of the RBA materials in your possession.

Mailing Lists

Click Here to Fill Out Mailing List Information

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