Membership Application

Membership Application
Chamber of Commerce Membership Application

PO Box 25, Antlers, OK 74523

info@pushcochamber.com

pushmatahachamber.com

(580) 298-2488
Type of Membership: (Individual $36, Business Membership $120, or VIP Business Membership $300)*
New Member OR Renewal*

NEWRENEWAL
Date*

MonthDayYear
Date
Business/Individual Name*
Business/Individual Address*
Business/Individual Phone Number*
Email*
example@example.com
Phone Number:*
Type of Business*
Facebook:*
Website*
Owner/Representative:*
Annual Membership Amount:*
- Select your business membership option below.
- Checkout with your membership dues.
- By signing the document, you agree to membership terms from calendar year (January to December).
*Membership may be tax deductible as a business expense. Head of firm/business will be listed as a voting member.

*A 3% filing fee is added to your membership dues total amount when paying with card. To avoid this fee, visit the chamber location to fill out your form and pay.

*Don't forget to download your business membership benefits on our website at www.pushcochamber.com/membership

Membership *

Business MembershipBusiness Membership

$125.00 Quantity

V.I.P. Business MembershipV.I.P Business Membership

$310.00 Quantity

Individual MembershipIndividual Membership

$38.00 Quantity

Total

$0.00

Thank you for your membership!