Talihina Chamber of Commerce
201 First Street
Talihina, OK 74571
MEMBERSHIP FORM
Business Name
Contact Person Name & Title
Street Address
Mailing Address (if different)
Business Phone
Format: (000) 000-0000.
Cell Phone
Format: (000) 000-0000.
Email
example@example.com
Website
Date
/
Month
/
Day
Year
Date
Completed By:
Please select which membership level best describes your business:
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( X )
Corporate: Banks, Utilities, Industrial
$350.00
$
350.00
Quantity
1
Business with 8 or more Employees
$200.00
$
200.00
Quantity
1
Small Business less than 8 employees
$125.00
$
125.00
Quantity
1
Churches & Organizations
$75.00
$
75.00
Quantity
1
2
3
4
5
6
7
8
9
10
Individuals: not affiliated with a business (politicians, volunteers)
$25.00
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Senior Citizen: not affiliated with a business
$10.00
$
10.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
Payment Type
Please Select
Credit Card
Check
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