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Member Application

Dear New Chamber Member, Welcome!
Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max): *

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words):

Sponsor:

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 YouTube Twitter Google Plus

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Social Networking:

LinkedIn Facebook YouTube Twitter Google Plus

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

Social Networking:

LinkedIn Facebook YouTube Twitter Google Plus

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Membership Package: *

Business with 1-5 Employees: $270.00
Business with 1-5 Employees, Partners or Agents Business with 6-10 Employees: $295.00
Business with 6-10 Employees, Partners or Agents Business with 11-15 Employees: $315.00
Business with 11-15 Employees, Partners or Agents Business with 16-20 Employees: $350.00
Business with 16-20 Employees, Partners or Agents Business with 21-30 Employees: $390.00
Business with 21-30 Employees, Partners or Agents Business with 31-50 Employees: $430.00
Business with 31-50 Employees, Partners or Agents Business with 51-75 Employees: $610.00
Business with 51-75 Employees, Partners or Agents Business with 76-99 Employees: $730.00
Business with 76-99 Employees, Partners or Agents Business with 100+ Employees: $1,105.00
Business with 100+ Employees, Partners or Agents Restaurant 1-60 Seats: $270.00
Membership dues will be based on number of seats Restaurant 61-130 Seats: $340.00
Membership dues will be based on number of seats Restaurant 130 Seats and up: $835.00
Membership dues will be based on number of seats Individual Membership: $180.00
Not a business or Profession Not-for-Profit 501(c) and Non-Profit (Charitable) 501 (c)(3): $185.00
Not-for-Profit 501(c) and Non-Profit (Charitable) 501(c)(3) with 10 employees or less. Over 10 employees use regular fee schedule. Pay it Forward - Platinum (membership included): $10,000.00
Pay it Forward- Gold (membership not included): $5,000.00
Pay it Forward- Silver (membership not included) : $3,000.00
Pay it Forward- Bronze (membership not included): $2,000.00
Pay it Forward- Chairman’s Circle (membership not included): $1,000.00
Pay it Forward- President’s Circle (membership not included): $500.00

Additional Fees:

Application Processing Fee : $25.00
Fee for set-up and processing membership application (nonprofits exempt)

Payment Option:

Charge my credit or debit card

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