Member Application

Thank you for your interest in joining the Chamber of Commerce. By completing and submitting the Membership Application you agree to the following. • Confirm that you are the owner/manager of this business with authority to enter into contracts on behalf of the business. • Agree to abide by the Chamber's Standards of Business Conduct & Ethics. • Have read and understand the Chamber's Privacy Policy and website Terms of Use. • Authorize the Chamber to publish your name, photo and/or business information in the Chamber's newsletter, online directory, print directory and other publications. • understand that the Chamber will use your email address for sending general communications and invoices. Membership Applications are subject to administrative and/or Board approval.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words):

Comments / Questions:

Referral Source: *

Referral Details:

Annual Sales:

Minority Owned:

Minority Certified:

Minority Certified Expire: Select mm/dd/yyyy

Women Owned:

Women Certified:

Women Certified Expire: Select mm/dd/yyyy

GLBT Owned:

GLBT Certified:

GLBT Certified Expire: Select mm/dd/yyyy

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 Twitter Google+ Pinterest Instagram Weddingwire.com Yelp YouTube

Primary Contact Information

First Name: *

Last Name: *

Title: *

Phone: *

Cell Phone: *

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook Twitter Google+ Pinterest Instagram Weddingwire.com Yelp YouTube

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

Login: *

Password: *

Social Networking:

LinkedIn Facebook Twitter Google+ Pinterest Instagram Weddingwire.com Yelp YouTube

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Print Application