Dr. Phillips Chamber of Commerce membership form

Dr. Phillips Chamber of Commerce Member Application

Choose from the options below to join
Name of contact person*

First NameLast Name
Contact person e-mail*
example@example.com
Company Name*
Company Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
Number of employees*
Year established*
Business description*
How did you hear about us?

Choose your membership level*

Basic Product Image

BasicOne year membership - For Nonprofits, Schools, City & Governmental Offices

$250.00

Individual Product Image

IndividualOne year membership - For one person company

$350.00

Business Product Image

BusinessOne year membership - For companies with up to 19 employees

$595.00

Business + Product Image

Business +One year membership - For businesses with 20 or more employees

$795.00

Gold Product Image

GoldOne year membership - Sponsor (Non-Exclusive)

$3,000.00

Platinum Product Image

PlatinumOne year membership - Sponsor (Exclusive Category)

$5,000.00

Total

$0.00

Credit Card

Signature*

Clear
payments are not refundable
Should be Empty: