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Membership Application
Name of firm, organization, or individual
_________________________________________
Street address
_________________________________________
Phone
_________________________________________
Mailing address
_________________________________________
Name of voting member
_________________________________________
Title
_________________________________________
Type of business or profession
_________________________________________
No. of employees
_________________________________________
Year business established
_________________________________________
Member Signature
____________________________Date_________
Membership Fees (Please check the appropriate box)
__Business owner and/or 1-6 employees $175
__Business--employees 7-25 $225
__Banks, savings with
more than 10 locations or more than 26
employees $225
__Associate members (employed by member
businesses or resident wishing to support
the Chamber.)$75
__My/our agreed membership investment
is $___
Total amount of check attached is $_____
We further understand that our investment in the Chamber of
Commerce is tax deductible as a business expense.
Please indicate your interest in one or more of the
following areas:
___Membership/Ambassador Club
___Business Development
___Newsletter
___Local Government Liaison
Event Planning
___Spring
___Summer
___Fall
___Winter
Insurance information is available upon request.
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