Member Application

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max): *

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words): *

Comments / Questions:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1:

Line 2:

City:

State:

Postal Code:

Country:

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Senior Friends of the Chamber: $30.00
(Must be 65 or older) Friend of the Chamber: $68.00
(Non-Business, Individuals & Families Only) Non-Profit Organizations: $115.00
Tiny Business (1 employee): $150.00
Business (2-25): $225.00
Maximum number of full and part time employees employed during the businesses peak time of year must be between 1 and 25. Business (26-99): $400.00
Maximum number of full and part time employees employed during the businesses peak time of year must be between 26 and 99. Business (100 and +): $600.00
Maximum number of full and part time employees employed during the businesses peak time of year must be over 100. Special Event: $50.00
Entitles your event to all the benefits of chamber membership in advance of that single date.

Payment Option:

Bill me

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