Member

Business Information

Company Name: *

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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:

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login:

Password:

Social Networking:

LinkedIn Facebook

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

Login:

Password:

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Connect: $250.00
Grow: $500.00
Build: $1,000.00
Influence: $2,500.00
Advocate: $5,000.00
Thoughtleader: $12,500.00
Small Business Membership: $100.00
Assist entrepreneurs, 1-4 Full time employees, Chamber Choice benefits, Marketing support and much more New Business Membership: $150.00
New business with in 1st year of opening, $150 for the first year of membership, ribbon cutting included.

Payment Option:

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Member Application

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