Verona Chamber of Commerce
New Member Application
Business Name
*
Contact Person
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Number
*
Fax#
E-mail
*
example@example.com
Type of Membership
*
Please Select
Small Business (under 50 employees) $100
Large Business (50+ Employees) $200
Resident $20 (suggested donation)
Non-profit $50
*An invoice will be mailed to the address you provide.
Type of Business/organization
Signature
*
Submit Registration
Should be Empty: