Membership Application
2023
Date
Business / Organization
Name
President / Owner
Local Manager / Director
Primary Contact Name & Title
Primary Contact Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Physical Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Website
Social Media Sites
Brief Description of Business / Organization
Membership
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( X )
Individual Membership
$
54.00
1st Time Chamber Member
$
90.00
Non-Profit Organization
$
120.00
Business
(Get a $50 discount for additional businesses owned by single entity - contact the Chamber)
$
180.00
Credit Card
Submit
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