Membership Application

Date Date / MM / DD YYYY
Organization Name *
Contact Name
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone * - ### - ### ####
Fax Fax - ### - ### ####
Cell Cell - ### - ### ####
Email *
Website Address
Year Established
Business Hours
Please give a short description of your business
Membership includes a listing on our Members Web Page, including business name, address, phone and fax numbers, contact name, e-mail address and business hours.
I am a business / organization with
(When counting the number of employees, please include yourself) *

I am a business / organization with
(When counting the number of employees, please include yourself) 1 – 2 Employees $105 3 – 6 Employees $130 7 or more Employees $150 10 or more employees $170 Financial Institution $250 Non-Profit (Church, School, Gov., etc.) $50 Friends of the Chamber (Individual) $50
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Featured Member - 1 month included in membership
Membership is January 1st through December 31st each year. Pro-rated after July 1st with paid membership for the next year.
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