Online Membership Application

Company Information
Company:
*
Address Line 1:
*
Address Line 2:
City:
*
State:
*
Zip:
*
Phone 1:
*
Phone 2:
Fax:
E-mail:
*
Website:
Bus. Category 1:
Bus. Category 2:
Bus. Category 3:
Full-time Employees:
*
Part-time Employees:
*
Additional Business Information
Established:
* 
Description of Business.
Referred by:
What do you expect to gain from your membership?
What is the one thing the Chamber can do to help your business or improve the value of your membership?
Is there anyone you would like to refer for membership in the Chamber?
Classification for Individual Membership (please check one)
Members-only Account Login
Members-only allows you to update your information online via a secure login.
Admin E-mail:
*
Password:
*
Verify Password:
*
Contacts
Primary Contact
Prefix:
First Name:
*
Last Name:
*
Suffix:
Familiar Name:
Title:
Mobile Phone:
*
 
I would like to receive communications from JACC via the following methods:
*By checking the options above, I authorize the Joplin Area Chamber of Commerce to send information to me through these methods.
Billing Contact
 
Additional Representative
You may add one additional representative below. More representatives may be added once the application has been processed.
 
Member Investment
$390.00 plus $5.00 for each full-time employee. (Two part-time employees are the equivalent of one full-time employee. Fractions of an employee will be rounded up to the nearest whole number.)
$390.00
Non-profit organizations with only a single location, and no employees.
$340.00
$180.00
Enrollment Fee:
$30.00
Total:
$0.00
*  
Security Code:
Please enter the security code above.
  
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