Member Application

New Member Application
(*) Denotes Required Fields
Company Information
Company: *
Address Line 1: *
Address Line 2:
City: *
State: *
Zip: *
Phone 1: *
Phone 2:
Fax:
E-mail: *
Web Site:
Online Links:
Business Category #1:
Please contact us with questions regarding business categories.
Full-time Employees:
Part-time Employees:
Primary Contact Person
Prefix:
First Name: *
Last Name: *
Suffix:
Familiar Name:
Title:
Address Line 1: *
Address Line 2:
City: *
State: *
Zip: *
Phone 1: *
Phone 2:
Fax:
E-mail: *
Billing Contact Person
Prefix:
First Name: *
Last Name: *
Suffix:
Familiar Name:
Title:
Address Line 1: *
Address Line 2:
City: *
State: *
Zip: *
Phone 1: *
Phone 2:
Fax:
E-mail: *
Business Info
Recruiter
Expectations
Please indicate your expectations for joining the Chamber.
What types of businesses/members are you hoping to meet?
Mentor
Investment Schedule
Business Type
Annual Investment:$350.00
Number of EmployeesAmount
1 thru 5$350.00
6 thru 10$400.00
11 thru 15$450.00
16 thru 25$525.00
26 thru 50$590.00
51 thru 75$700.00
76 thru 100$800.00
101 thru 150$920.00
151 thru 200$1,215.00
201 thru 300$1,575.00
301 thru 400$1,800.00
401 thru 500$2,050.00
501 thru 600$2,350.00
601 thru 750$2,585.00
Over 750 Employees$2,850.00
Additional Directory Category(s)
#2:   x 0.00Free
#3:   x 25.00$0.00
#4:   x 25.00$0.00
#5:   x 25.00$0.00
Enrollment Fee$25.00
__________
Total:$375.00
Payment Options
If you would like to add an additional branch or representative to your company listing, please contact Cathy Young at 816-524-2424.
(*) Denotes Required Fields

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