New Member Application
(*) Denotes Required Fields
Company Information
Company: *
Address Line 1: *
Address Line 2:
City: *
State: *
Zip: *
Phone 1: *
Phone 2:
Fax:
E-mail: *
Web Site:
Online Links:
Business Category #1:
Please contact us with questions regarding business categories.
Full-time Employees:
Part-time Employees:
Members-only Access
Members-only allows you to update your information online via a secure login.
Admin E-mail: *
Password: *
Verify Password: *
Primary Contact Person
Prefix:
First Name: *
Last Name: *
Suffix:
Familiar Name:
Title:
Mobile Phone:
Address Line 1: *
Address Line 2:
City: *
State: *
Zip: *
Phone 1: *
Phone 2:
Fax:
E-mail: *
Billing Contact Person
Prefix:
First Name: *
Last Name: *
Suffix:
Familiar Name:
Title:
Mobile Phone:
Address Line 1: *
Address Line 2:
City: *
State: *
Zip: *
Phone 1: *
Phone 2:
Fax:
E-mail: *
Additional Company Representatives
You may add one additional representative below. More representatives may be added once the application has been processed.
Prefix:
First Name: *
Last Name: *
Suffix:
Familiar Name:
Title:
Mobile Phone:
Address Line 1: *
Address Line 2:
City: *
State: *
Zip: *
Phone 1: *
Phone 2:
Fax:
E-mail: *
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?
Additional Business Category(s)
Business Category #2:
Business Category #3:
Member Investment
$370.00 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.)
Annual Investment:$370.00
Enrollment Fee$30.00
__________
Total:$30.00
Payment Options
(*) Denotes Required Fields