NRG Membership Application

Complete your membership application today!

Business Information

First Name*

Last Name*

Business Name*

Business Category*

The business category for which you are applying must not duplicate a category of an existing member. If the existing member agrees, a category can be split to accommodate the new member (For example, Insurance could be split between Life Insurance and Property and Casualty). If there is a question, we will first contact the member with the related category and will then contact you for any clarification.

Address Line 1*

Address Line 2

City*

State*

ZIP Code*

Phone Number*

Alternate Phone Number

Email Address*

Web Address

Business References

First Name*

Last Name*

Business Relation*

(Client, partner, vendor, etc.)

Phone Number*

First Name*

Last Name*

Business Relation*

(Client, partner, vendor, etc.)

Phone Number*

First Name*

Last Name*

Business Relation*

(Client, partner, vendor, etc.)

Phone Number*

I understand I may need to submit proof of required insurance or licensing for my trade/profession. I also understand that if I do not keep these documents current, my membership will be revoked.*

I authorize the verification of the information provided on this form and give NRG Rochester representative permission to contact references listed.*

By applying for membership, I agree to abide by the NRG Operating Procedures.*

Annual Membership Dues (includes all fees for meeting room and coffee): $395
(Due upon review and approval by NRG members.)

NRG Membership Application

Complete your membership application today!

Business Information

Business References

About NRG

Resources