Member

Business Information

Company Name: *

Leave Blank:

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: *

Social Networking:

LinkedIn Facebook Twitter

Primary Contact Information

First Name: *

Last Name: *

Title: *

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook Twitter

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 Twitter

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Prorated Member-Friend: $25.00
Half Year Friend membership (June - Dec) Prorated Home Based : $38.00
Home Based - Half Year (June - Dec) Prorated Member-Non-Profit: $50.00
Non-Profit - Half Year (June- Dec) Prorated Member-Tier I: $100.00
1-10 Emp. - Half Year (June - Dec) Prorated Member-Tier 2: $150.00
11-30 Emp. - Half Year (June - Dec) Prorated Member-Tier 3: $250.00
31+ Emp. - Half Year ( June - Dec) Prorated Member-Corporate : $500.00
Corp Member - Half Year (June - Dec)

Additional Opportunities:

We will contact you with additional information.

Gold Series Website Advertising : $30.00
The Gold series are the most utilized pages on the chambers website. Gold packages have 2 banner spots each 30 day period and are first come first serve. Banners must be no larger than 480 X 60 Pixels.Design services are available with purchases of 60 days or more.

Payment Option:

Bill me Charge my credit or debit card

Member Application

Mailing Address

Address

Address