United Regional Chamber of Commence
We're not just a chamber. We're a chamber of connections
Application for Membership
Please complete all of the following fields before submitting.
General Information
Business Name
*
The name of your organization, entity, company, non-profit, etc.
Type of Business
*
Website Address
*
In lieu of a website URL, please provide the URL that directs to your social media page,
Business Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Physical Address
Street Address
*
City/Town
*
State
*
Zip Code
*
Billing/Mailing Address
Is billing address the same as physical address?
*
Yes
No
Street Address
*
City Town
*
State
*
Zip Code
*
Payment Method
Choose how you will pay for your membership.
Payment Method
ACH
ACH 12 Monthly Payments
Credit Card
Check
Venmo
Billing Contact
This is the person as your company/organization who will handle the membership payment
Billing Contact Name
*
Billing Contact's Email Address
*
example@example.com
Billing Contact Phone
*
Format: (000) 000-0000.
Note: If by credit card, please provide billing email address. Invoice will be sent via PayPal email.
Primary Contact
This is the person we should contact them to provide any updates about membership events and opportunities with the Chamber
Is the primary contact the same person as the billing contact?
Yes
No
Primary Contact Name
*
Primary Contact Phone
*
Format: (000) 000-0000.
Primary Contact Email
*
example@example.com
Referred By
*
Or how did you hear about us.
Note: If by credit card, provide billing email address. Invoice will be sent via PayPal email.
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