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Company name:____________________________________________ 

Phone: _______________________ Fax: _______________________

 
Email: ________________________ Website: ____________________ 

Facebook: _________________ LinkedIn: ______________________

 
Employees: FT ____________ PT_____________

 
Physical address: __________________________________________

 
City/State/Zip: _____________________________________________

 
Mailing address (if same leave blank):_______________________

 
City/State/Zip:_____________________________________________

Primary contact:___________________________________________

 
Title: _______________________ Phone: _______________________

 
Email: _____________________________ Fax: ___________________

Membership options: 

☐start & grow ($250) less than 5 employees ($125.00)
☐develop & connect ($550)
☐involve & innovate ($850)
☐foundation & pillar ($1500)
☐chamber champion (Individuals)($75.00)
☐chamber ally (non-profit – excl. Education Inst.)($125)

Send check or money order with application!