Join the Chamber

New Member Application

Company Information
Company:
*
Address Line 1:
*
Address Line 2:
City:
*
State:
*
Zip:
*
Phone 1:
*
Phone 2:
Fax:
E-mail:
*
Website:
Bus. Category 1:
Bus. Category 2:
10.00
Bus. Category 3:
10.00
Bus. Category 4:
10.00
Bus. Category 5:
10.00
Full-time Employees:
Part-time Employees:
Additional Business Information
Business Description:
Enter keywords related to your business below, separated by a space or comma.
Referred By:
Why are you joining?
Expectations:
Area that you serve:
Contact preference:
Members-only Account Login
Members-only allows you to update your information online via a secure login.
Admin E-mail:
*
Password:
*
Verify Password:
*
Contacts
Primary Contact
Prefix:
First Name:
*
Last Name:
*
Suffix:
Familiar Name:
Title:
 
Billing Contact
 
Annual Investment Memberships
2 part time employees = 1 full time emlpoyee
Employees
Amount
0-2
175.00
3-5
235.00
6-25
290.00
26-100
350.00
101-350
405.00
351+
580.00
175.00
$115.00
2 part time employees = 1 full time emlpoyee
Employees
Amount
0-2
157.50
3-5
211.50
6-25
261.00
26-100
315.00
101-350
364.50
351+
522.00
157.50
For the first year of membership. Dues will increase by 1/3 of dues level, based on number of emplyees, each year afterward for next two years
$105.00
Special membership for an independent contractor of a member company. This is a limited membership which includes advertising, networking, & other promotional opportunities.
$50.00
Special membership for additional office location of a "same name" member company.
$165.00
Total:
$0.00
Security Code:
Please enter the security code above.
  
Powered By CC-Assist.NET