Company:
Email Address:
link will be displayed on chamber website
Website:
link will be displayed on chamber website
Street Address:
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Zip:
Telephone:
Fax:
Representative:
Representative Email:
Representative:
Representative Email:
Representative:
Representative Email:
Please list additional representatives in the comments at the bottom of this form.
Annual Investment
Membership Category
$1,200
Gold Members
(includes 4 free luncheons, 1/2 page ad in newsletter, window decal, logo on Chamber website main page with link to your website, logo on PowerPoint presentation at luncheons)
$650
Sustaining Members
(includes 2 free luncheons, 1/4 page ad in newsletter, window decal, logo on Chamber website main page with link to your website, logo on PowerPoint presentation at luncheons)
$600
Industry/Government
Large Industry, Government Installations, Public Utilities
$300
Corporate
Financial Institutions, Large Retailers, Motels, Auto Dealerships, Small Industries
$185
Business
Small Retailers, Real Estate Brokers, Licensed Professionals
$125
Small Business
Small Business, 0-2 Employees
$75
Non-Profit
$65
Individual
Number of Full-time Employees:
Number of Part-time Employees:
Business Category:
Tell us about your business:
Information will be on Chamber Website
Would you like to purchase a Luncheon Punch Card?
YES NO
(add $90 for 10 lunches, you'll get 1 free lunch with the purchase of a punch card)
Who can we thank for referring you to us?
Any additonal comments?