Greater Valley Chamber Membership Application

Date*

Date

Yes! / want to invest in the future of the Valley by supporting the Chamber's programs dedicated to supporting economic development and serving as a voice for all businesses in our region.

Business Name*

Established*

Primary Contact Name*

Title*

Location Address*

City/State/Zip*

Billing Address - if different, please include City, State & Zip

Main Phone*

Contact Direct Phone - if different

Fax

Cell Phone

Company email*

example@example.com

Contact direct email - if different

example@example.com

Business Web Address

Facebook

Other Social Media

Business Category (Please note our formula is similar to the yellow pages)*

Does your profession require that you have a license or certification? If yes, please include license number:

Federal Tax ID number

Number of Full Time Employees*

Number of Part Time Employees*

Additional Contacts to receive Chamber Information:

Name

Position

Direct Phone

email

example@example.com

Name

Position

Direct Phone

email

example@example.com

Membership Investment Schedule - Annual Dues Amount*

$370 (Solopreneur) + $25 application fee$395 (2-5 Employees) + $25 application fee$450 (6-10 Employees) + $25 application fee$580 (11-20 Employees) + $25 application fee$735 (21-30 Employees) + $25 application feeContact Laura for over 30 employees, Banks, Universities, & Utilities

For payment, I will

Mail CheckCall with Credit CardPlease Invoice Me

I hereby apply for acceptance as a Member of the Greater Valley Chamber of Commerce. I understand that membership is continuous unless cancelled in writing. For federal income tax purposes, membership in the Greater Valley Chamber of Commerce, as well as any other payments to the Chamber, may be deductible, as ordinary and necessary business expenses and not as a charitable contribution. I hereby accept the terms and conditions above and am authorized to sign for the applicant.

Authorized Signature

Title