Chamber Membership Application

Name of Firm*

Phone Number*

Area CodePhone Number

Title*

Street Address*

Mailing Address (if different)

City*

State*

ZIP/Postal Code*

Country*

Contact Name*

First NameLast Name

Fax Number

Area CodePhone Number

E-mail*

Web Address

Year Established*

Facebook

Twitter

Category Listing (Up to 3 per member, enter one per line)

My business is certified in the following categories (check all that apply) ...

Women-ownedVeteran-ownedMinority-owned

Please include my company in the Chamber's online business directory:

YesNo

Please include my company web address in the Chamber's online business directory:

YesNo

If you would like to list an email address in your entry in the online business directory, please enter it in the field below. NOTE: This email address can be the same or different than the address you entered above. If you leave the field below blank, we will NOT include your email in our directory.

Would you be interested in serving on a committee?*

YesNot at this time

How did you hear about the Chamber?*

Referred by (if applicable):

How many employees in your organization?

	Number of Employees
Owners
Full-time
Part-time

Please note: Dues for business owners with multiple locations or related businesses (e.g. auto groups, banks, etc.) are calculated based upon the largest entity category plus $100 per listed subsidiary. Please call the Chamber (716-662-3366) for specific pricing, or download and complete the PDF version of the membership application and return it to us via US mail with your check.

Enter the message as it's shown*

IMPORTANT: All new and existing members of the Orchard Park Chamber of Commerce are required to read, understand, and abide by the Chamber's CODE OF CONDUCT.

You can view this document here.

I have read, understand, and agree to abide by the Orchard Park Chamber of Commerce's Code of Conduct.*

Yes

Important ... by hitting the "Submit" button below:

I agree to receive communications sent by the Orchard Park Chamber of Commerce via e-mail. Notification for meetings can be made to any or all addresses provided on this application. The Chamber will not publish either the e-mail address (unless you specifically permit us to do so) or fax number and will not intentionally provide them to any other entity. This consent may be revoked by written notification at any time.

I acknowledge that contributions or gifts to the Chamber are not tax-deductible as charitable contributions. Chamber membership dues may be deductible as an ordinary and necessary business expense.

My Products

Annual Business Membership: 0-5 employees$250.00

Annual Business Membership: 6-10 employees$315.00

Annual Business Membership: 11-20 employees$340.00

Annual Business Membership: 21-50 employees$395.00

Annual Business Membership: 51-100 employees$455.00

Annual Business Membership: 101+ employees$620.00

Annual Associate Membership (individuals, charitable and community organizations only)$115.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.