Chamber Member Directory Intake & Sign Up Form

Chamber Membership Directory Information & Sign Up Form

Please complete all information for our online directory
Name*

First NameLast Name
Business name and brief description of business and what your business does/sells/provides.*
Business Type*
Number of Employees*
Google Business Profile Link
Consent: permission to use logo, photos, and description in Chamber marketing*
Business or Home Address (Whichever you prefer for the directory - This is public)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Do you want this this address added to the directory?*
E-mail*
example@example.com
Work Number*
Format: (000) 000-0000.
Cellular Number*
Format: (000) 000-0000.
Which number do you want on the directory? *
Facebook Page Link*
Instagram Page Link
LinkedIn Page Link
Website*
Other Social Media
Is your business Women Owned/Veteran Owned*
When was your business established. Date/Year (For spotlights and social media recognition)*
What would you like to see at future chamber meetings? What would benefit and help you as a business? *
Are you interested in joining any committees to help the board? *
Would you like to schedule a ribbon cuttingInterested in being featured in a member spotlightInterested in hosting a Chamber eventInterested in offering member discounts or specialsAny upcoming promotions or announcementsN/A
NetworkingBusiness referralsCommunity involvementMarketing exposureEducation and training
Tell us something unique about your business*
Signature*

Powered by Jotform SignClear
Signing Date*

MonthDayYear
Date
2026-2027 Membership Dues*
prevnext( X )
2026-2027 Chamber Membership
March 2026-June 30, 2027

$200.00 Quantity

PAY BY CHECK - EMAIL valleystationchamber72@gmail.com **
$ Free Quantity

Total

$0.00
Payment Methods

Choose from one of the PayPal options to make your payment.
Should be Empty:

Chamber Membership Directory Information & Sign Up Form