Membership Application or Membership Renewal

Business Information & Contact Person

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * Job Title:
• * Phone:
• * Business Name:
• *

  Membership Status:

  • New Member
  • Renewing Member

• Fee

  Type	Fee
  Membership (1-5 employees)	$275.00
  Membership 2	$280.00
  Membership 3	$285.00
  Membership 4	$290.00
  Membership 5	$300.00
  Membership 6	$315.00
  Membership 7	$325.00
  Membership 8	$340.00
  Membership 9	$350.00
  Membership 10	$355.00
  Membership 11	$360.00
  Membership 12	$375.00
  Membership 13	$400.00
  Membership 14	$415.00
  Membership 15	$500.00
  Membership 16	$525.00
  Membership (100+ employees)	$750.00

Your Business Directory information (New Members Only, please fill this out)

• Address 1:
• City:
• State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• ZIP Code:
• Phone:
• Website:
• Type of Business:
• Referred to Chamber by:
• How many full-time employees?

Pre-pay next year+ Information

You may add a maximum of 10