Name of Business or Organization: (required)

Primary Contact Name: (required)

Phone Number: (required)

Fax:

Street Address:

City/State/Zip:

Email Address:

Website:

Business Category (type):

Name of Chamber Membership Sponsor:

Membership Appliation Fees
* $25 one-time application fee plus the following
$175 (1-5 employees)
$250 (6-10 employees)
$350 (11-25 employees)
$450 (26-50 employees)
$500 (51-99 employees)
$600 (100-199 employees)
$700 (200-299 employees)
$750 (300-399 employees)
$800 (400-499 employees)
$850 (500 or more employees)
$850 utilities and hospitals
$550 banks and S & L's
$125 civic organization
$125 individuals (Individual category listing only)
$100 retirees

Extra Category(s) Listing @ $25 each:

Tag Line for Membership Directory and Web Site @ $25:
(this will appear under the business name)