Name of Business*

Contact Name*

Physical Address*

Mailing Address*

Phone*

Fax

Email*

Type of Membership*
Individual (Senior) $15Individual $30Home Business $65Small Business $100 (1-5 employees)Medium Business $150 (6-10 employees)Large Business $200 (10+ employees)Corporate $450Professional $200 (attorneys, dentists, clinics, etc.)Churches & Civic Clubs $50 (all non-profits)

How many employees do you currently have?*

What can the Chamber do for you?*

In what areas do you feel the Chamber needs to improve?*