Membership Application




 
Please fill out the following information, and we will contact you about joining the chamber!
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Organization Information (to be displayed online)
Organization Name *
Address 1 *
Address 2
City *
State *
Zip *
Phone *
Fax
Website
Email *
Main Contact
First Name *
Last Name *
Address 1 *
Address 2
City *
State *
Zip *
Title
Phone *
Email *
Additional Contacts
Billing Address (if different)
Street
City
State
Zip
Mailing Address (if different)
Street
City
State
Zip
Additional Information
Do you want your physical address listed in web and print directories?
Yes No
Preferred Communications?
Email Mail
Optional: Minority-Owned?
Yes No
Description of your business (20 words or less)
Reason for Joining
Membership Investment
Membership Type: *
Primary Directory Category *
Number of Full Time Employees:  
Number of Part Time Employees:  
Number of Rooms (Accommodations):  
Number of Associates (Realtors, Attorneys):  
Millions in Assets (Financial Institutions):  
Additional Locations ($25 each):
   
$ 
Total: $ 

The contents of this box are for testing purposes. This box will be removed when the form goes live.
Full-Time Employees
Part-Time Employees
Hotel/Motel Rooms
Restaurant Seats
Additional Associates
Additional Associates Cost
Additional Locations
Additional Locations Cost
Assets
Assets Cost
AdditionalCategories
Additional Categories Cost
NumberOfAdditionalCategories
additionalItem1Cost
additionalLocations
Annual Dues (charged to card)
Tax (charged to card)
Fee (charged to card)
tempValueForDropDown1
Additional Directory Categories
  • Primary Dirctory listing is complimentary
  • Up to two additional Dirctory listings are complimentary
  • After two, additional Directory listings are $35 each
**Hold CTRL on your keyboard to select multiple categories**
Number of Seats (Restaurants):  
Number of Locations ($35/add. location):  
Enhanced Membership ($50):
$ 
$ 
*
NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.
Credit Card Information
Credit Card Type *
Credit Card Number *        
Name On Card
Security Code
Valid Through
Credit Card Address 1
Credit Card City
Credit Card State
Credit Card Zip
Credit Card Phone Number

Please type the above letters for verification purposes.
Please click submit only one time.  The transaction may take several seconds.