Membership Application

 
   
Organization Information (to be displayed online)
Organization Name *
Address 1 *
Address 2
City *
State *
Zip *
Phone *
Fax
Website
Email *
Main Contact
First Name *
Last Name *
Address 1 *
Address 2
City *
State *
Zip *
Title
Phone *
Email *
Additional Contacts
Billing Address (if different)
Street
City
State
Zip
Mailing Address (if different)
Street
City
State
Zip
Additional Information
Business Description
How did you hear about The Chamber of Commerce?
So that we may serve you better, please let us know which Chamber benefits may be of interest to you or your employees.
*Check all that apply
Employee Benefits including Medical, Life, and Disability Insurance
Advertising/Marketing
Grand Opening/Open House
Human Resource Consulting
Member-to-Member Discounts
Networking Events
Shoptauqua Gift Checks
Skill Building Workshops
Workforce Development
Membership Investment
Membership Type: *
Primary Directory Category *
Additional Directory Categories
  • You may choose up to two additional categories
**Hold CTRL on your keyboard to select multiple categories**
Number of Full Time Employees:  
Number of Part Time Employees:  
Total Dues from Number of Employees: $
Shoptauqua Gift Check Program Participant
($40 value, free to new members for the first year):
Display ad in The Voice, the Chamber’s e-newsletter for $100 ($150 value):
Three month banner ad on the Chamber web site for $50 ($75 value):
Optional $25 donation to the Chamber technology fund:
   
Total: $ 

The contents of this box are for testing purposes. This box will be removed when the form goes live.
Full-Time Employees
Part-Time Employees
Hotel/Motel Rooms
Restaurant Seats
Additional Associates
Additional Associates Cost
Additional Locations
Additional Locations Cost
Assets
Assets Cost
AdditionalCategories
Additional Categories Cost
NumberOfAdditionalCategories
additionalItem1Cost
additionalItem2Cost
additionalItem3Cost
additionalItem4Cost
Annual Dues (charged to card)
Tax (charged to card)
Fee (charged to card)
tempValueForDropDown1
*
NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.
Number of Rooms (Accommodations):  
Number of Seats (Restaurants):  
Number of Associates (Realtors, Attorneys):  
Number of Locations ($35/add. location):  
Millions in Assets (Financial Institutions):  
$ 
$ 
$ 
Credit Card Information
Credit Card Type *
Credit Card Number * 
Name On Card
Security Code
Valid Through
Credit Card Address 1
Credit Card City
Credit Card State
Credit Card Zip
Credit Card Phone Number
Please click submit only one time.  The transaction may take several seconds.

Membership provides valuable networking experiences and improved visibility! Learn more about the benefits of membership or join today.

FIND A BUSINESS

From accountants to manufacturers to wineries, you can find the products and services you need in our searchable business directory. Search by keyword or category to get the results you want.

FIND AN EVENT

Looking to network or learn more about public policy that affects your business? We have a variety of events to suit your needs.

CONTACT US

Need more information about the Chamber, our benefits, or events? Contact us now.