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 the billing address the same as the 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
Note: If by credit card, please provide billing email address. Invoice will be sent via PayPal email.
Billing Contact
This is the person at your company/organization who will handle the membership payment.
Billing Contact Name
*
Billing Contact Phone
*
Format: (000) 000-0000.
Billing Contact Email
*
example@example.com
Primary Contact
This is a person we should contact 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.
Preview PDF
Submit
Should be Empty: