Member

Business Information

Company Name: *

Leave Blank:

Phone: *

Website: *

Email: *

Business Description (200 char max): *

Directory Category: *

Employees: *

Full-time Part-time

Comments / Questions:

What is your top reason for joining the Chamber?: *

Other:

How did you find out about the Chamber?: *

Referred by:

This business is a non-profit: *

Is this business Female Owned?:

Is this business Minority Owned?:

Is this business Military Owned?:

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: *

Social Networking:

LinkedIn Facebook Twitter

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook Twitter

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

Login: *

Password: *

Social Networking:

LinkedIn Facebook Twitter

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Non-Profit Membership: $159.00
Must be a classified as a not for profit organization. Membership Level 1: $335.00
0-5 full and/or part-time employees at your business or facility Membership Level 2: $347.00
6-15 full and/or part-time employees at your business or facility. Membership Level 3: $464.00
16-25 full and/or part-time employees at your business or facility. Membership Level 4: $734.00
26-50 full and/or part-time employees at your business or facility. Membership Level 5: $963.00
51-100 full and/or part-time employees at your business or facility. Membership Level 6: $1,195.00
101-250 full and/or part-time employees at your business or facility. Membership Level 7: $1,588.00
251-500 full and/or part-time employees at your business or facility. Membership Level 8: $2,142.00
501-above full and/or part-time employees at your business or facility.

Payment Option:

Bill me Charge my credit or debit card

Member Application

Mailing Address

Address

Address