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2010 Membership Form
Membership Categories (Please
Check One)
Home Based Business $175
Non-Profit Organization $100
Under 5 Employees $250
Under 20 Employees $300
Under 50 Employees $350
Under 100 Employees $400
Over 100 Employees $500
Associate Member $175
(Includes Retired
Individuals, Clergy,
Elected Officials,
and Community Members)
Please use the form below to make any
changes:
Today’s Date: (mm/dd/yy)
Business Name:
Primary Contact:
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Phone: (
) -
Fax: (
) -
E-mail:
Website:
YES! I would like to add an additional
amount of $
, for Chamber technology updating.
Number of Employees:
Type of Business:
Type of Business (Additional Category):
Type of Business (Additional Category):
If you would like your business listed
in more than one category, please select the extra listing(s) above
and add $25 per additional listing.
Names of others in your organization
that would like to receive Chamber Information and Newsletter.
Name:
Email:
Name:
Email:
Submit Application
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