Membership Application

Membership Criteria:

Business must be privately owned
The stock of the company, if incorporated, cannot be publicly traded
The business entity is the actual member
The benefits and services are then available to all owners, employees and family members of that business
Business must operate at least 30 hours per week to qualify for health and dental benefits
Non-profit agencies, self-employed and home based businesses are eligible

Memberships approved during the 4th quarter will be invoiced for one year. The fourth quarter of this year will be complimentary.

To join TIBA, Fill out and submit the digital form below.
Alternatively, print and fill out form at the bottom of the page.

Application

Business Name *

Contact (First Name) *

Contact (Last Name) *

Business Address (Published online in TIBA Directory) *

City *

State *

Zip *

County

Phone *

Fax

E-mail (for public contact) *

Website

Type of Business *

This description will be used in the TIBA membership directory.

Number of Full Time Employees

Billing Address (if different than business address - will not be published.)

City

State/Province

Zip/Postal

Referred By *

Membership Categories & Dues

Business with 1-5 employees $150

Business with 6-10 employees $250

Business with 11-25 employees $300

Business with 26-50 employees $350

Business with 51 or more employees $400

Individual membership $150

Payment By

Pay now with Card

Invoice Me (with options to pay via card or check)

In Trade (Deferred for trade in services)

Business you can refer to TIBA **

Business Name

Referral Business Contact Person

Referral Business Address

City, State, Zip

Referral Business E-Mail

Business you can refer to TIBA **

Business Name

Referral Business Contact Person

Referral Business Address

City, State, Zip

Referral Business E-Mail

Please write a little about yourself/your business here so we can share about you to our group. Make it like a little advertisement for your business.

Total Due *

Amount will be prorated if not joining in January when yearly billing cycle begins.

Pay now with Credit Card

Captcha

If you are human, leave this field blank.

If you would rather pay by check, please download, print, complete, and mail in the Application found HERE.

The Topeka Independent Business Association is organized to promote the formation, growth and viability of small and independently owned businesses in the Topeka area.

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The Topeka Independent Business Association is organized to promote the formation, growth and viability of small and independently owned businesses in the Topeka area. Please explore our website to learn more about us.