Member Application

To become a new member of our Chamber of Commerce, please complete this form. If you would like to review membership categories and pricing before entering your membership information, scroll to the bottom of this page.

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): *

Comments / Questions:

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 Instagram

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook Instagram

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

Password: *

Social Networking:

LinkedIn Facebook Instagram

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Small Business: $275.00
Less Than 10 Employees Medium-Sized Business: $450.00
Between 10-49 employees (full-time equivalent employees) Large Business: $650.00
50+ Employees (Full-Time Equivalent employees) Non-Profit Organization: $200.00
Friend of the Chamber: $150.00
Individual

Payment Option:

Bill me Charge my credit or debit card

Print Application