Name *

First Name

Last Name

Employment Status

Please check all that apply.

Employed

Self-Employed

Retired

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Terms and Conditions *

YOU HAVE INDEPENDENTLY EVALUATED THE DESIRABILITY OF THE MEMBERSHIP AND ARE NOT RELYING ON ANY REPRESENTATION AGREEMENT, GUARANTEE OR STATEMENT OTHER THAN YOUR OWN CONSIDERED OPINION. YOU AGREE TO ABIDE BY THE CHAMBER’S BYLAWS AND UPHOLD ITS MISSION AND VISION.

I agree to the Terms and Conditions

Membership Category *

Please choose your applicable category.

Business (1-3 employees) - $200

Business (4-10 employees) - $300

Business (11-50 employees) - $500

Business (51-100 employees) - $750

Business (101-250 employees) - $1000

Business (251+ employees) - $1250

Nonprofits w/ operating budget < $50k - $100

Nonprofits w/ operating budget > $50k - $200

Student (provide proof of enrollment) - $30

Associate (professional, individual employee) - $100

Date

MM

DD

YYYY