Member Application

Welcome to Central Exchange! We're so excited you've decided to become a CX member. Please complete the registration form below to get started with your membership. If you have any questions regarding membership or this form, please email hello@centralexchange.org.

Step 1:

Member Info

Company Name *

Please add your company name.

Physical Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Zip Code *

Please add your Zip Code.

Mailing Address

Same as physical address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Zip Code *

Please add your Zip Code.

Step 2:

Additional Info

PERSONAL INFO

What is your gender?

What is your race?

Your pronouns

Education

What prompted your membership application to CX?

Birth Month & Year (MM/YYYY) Ex: 01/1980

Personal Email Address *

Looks good!

Work Email Address *

Looks good!

Preferred email (for CX communications) *

Looks good!

If a member referred you, please leave their name!

Step 3:

Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title

Phone

Cell Phone *

Please add your cell phone number.

Create Account

Password *

Please add your login password.

Step 4:

Billing Contact

Same as Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title

Phone

Cell Phone *

Please add your cell phone number.

Create Account

Password *

Please add your login password.

Step 5:

Membership Package

Please select a Membership Package

CX Membership | Annual Dues $ 480

Make it easy! Pay annual dues of $480

CX Membership | Quarterly Dues $ 120

Want to spread it out a bit? Pay quarterly dues of $120

CX Membership | Monthly Dues $ 40

Or pay monthly dues of $40

Additional Fees:

Policy

Your CX Membership does not expire. If you wish to cancel your membership, please email hello@centralexchange.org a minimum of 5 days before the last business day of the month before your next billing cycle. Refunds are not provided for members who do not wish to complete their current, paid term.

Comments/Questions

Payment Option

Charge my credit or debit card

Please complete the Captcha

I have read and accept the privacy policy of Central Exchange. I grant Central Exchange permission to contact me regarding my account, news, updates, and offers.

Please read and accept the privacy policy before continuing.

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