Business Registration Form

Devine Chamber of Commerce

Think Local.
Business Owner *

First Name Last Name
Years in Business
How many years has your company been in business?
Membership *

New Member Renewal
Type of Business *
Other:
Business Name *
Point of Contact *

First Name Last Name
Contact Number *

Area Code Phone Number
E-mail *
Website *
Business Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Anything else we should know?

Choose your membership type:

Business/Organization ( $ 125.00 for each year )

This allows TWO marquee slides on the digital sign in front of the Community Center to advertise for your business.

Business/Organization ( $ 75.00 for each year )

This allows ONE marquee slide on the digital sign in front of the Community Center to advertise for your business.

Individual Membership ( $ 40.00 for each year )

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Should be Empty:

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