Chamber Membership Application

Name of Business/Organization:

Designated Contact:

Title:

Address Line 1:

Address Line 2:

City:

State:

Zip:

Area Code/ Phone:

Fax:

Email:

Web site:

Type of business:

# of employees:

Date your business/ organization was established:

Describe your business/organization:

Membership Categories ~ Please select up to three
Click here to view complete list of categories

Category 1:

Category 2:

Category 3:

Would you like to appear on Chamber Web Site?
(No Additional Charge)

Yes
No

Are you interested in a link from our web site to yours?:
(No Additional Charge)

Yes
No

INVESTMENT:
(determined by the number of Employees including Owners)
Click here for Dues Schedule

METHOD OF PAYMENT:

ANNUAL
MONTHLY
QUARTERLY
SEMI ANNUAL

PAYMENT INFORMATION:

Billing Name:

Billing Address:

City, State Zip:

Credit Card Type:

Visa
Mastercard

Credit Card Number:

Credit Card Expiration:

Bank Draft is required with monthly, quarterly or semi annual methods (include 1st payment & voided check)
PLEASE REMIT PAYMENT WITH APPLICATION

All applications are reviewed for approval by the Board of Directors. Memberships approved by the Board of Directors will begin upon the payment of the prescribed membership dues. Dues are not deductible as charitable contributions for income tax purposes. Dues may be considered ordinary and necessary business deductions.