| Membership Application |
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| Business Name: |
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| Address: |
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| PO Box: |
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| City |
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| State: |
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| Zip: |
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| Phone: |
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| Fax: |
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| Website: |
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| Email: |
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| Membership Contact: |
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| Billing Contact: |
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| Business Description: |
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| Preferred Method of Contact: |
Email
Fax
Standard Mail |
How did you hear about
Chamber Membership? |
Chamber Staff
Ambassador
Board Member
Chamber Member
Membership Drive
Other (please describe)
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| Investment Schedule |
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| A. CONSTRUCTION, HOME BASED, INSURANCE, LODGING, MEDIA,
MORTGAGE, PRINTING, RETAILERS, SERVICES, TRANSPORTATION |
| Base Rate: 1 to 5 employees: $198.00 |
6 to 10 employees: $220.00 |
| 11 to 15 employees: $245.00 |
16 to 20 employees: $265.00 |
| 21 to 30 employees: $285.00 |
31 to 40 employees: $330.00 |
| 41 to 50 employees: $385.00 |
51 to 100 employees: $710.00 |
| 101 to 200 employees: $1,108.00 |
201 to 300 employees: $1,438.00 |
| 301 to 400 employees: $1,760.00 |
401 to 600 employees: $2,090.00 |
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| B. INDIVIDUALS/NON-PROFIT CIVIC GROUPS |
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Base Rate: $75.00 |
| C. PROFESSIONAL - ACCOUNTANTS, ARCHITECTS,
ATTORNEYS, C.P.A.’S, DENTISTS, DOCTORS, D.V.M.’S, INVESTMENTS,
PROFESSIONAL OFFICES |
| Base Rate: 1 to 5 employees: $220.00 |
6 to 10 employees: $225.00 - $245.00 |
| 11 and up: $ 275.00 |
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| D. REAL ESTATE |
| Base Rate: 1 to 5 employees: $220.00 |
6 to 10 employees: $245.00 |
| 11 to 20 employees: $295.00 |
21 and up: $350.00 |
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| E. RESTAURANTS |
| Base Rate: 1 to 10 employees: $198.00 |
11 to 15 employees: $225.00 |
| 16 and up: $245.00 |
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| F. SPECIALIZED CATEGORIES - Contact Chamber
Staff |
| Apartments/Condos |
Automotive Sales |
| Clinics/Hospitals |
Education |
| Financial Institutions |
Government |
| Manufacturing/Industry |
Nurse/Assisted Living |
| Public Utilities |
Publishing |
| Retail (5 mil. & up) |
Retirement Facilities |
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| Date: |
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| Average Employment: |
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| We agree to invest annually: $ |
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| or quarterly: $ |
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| Total enclosed: $ |
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Check
MasterCard
Visa |
| Card # : |
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| Exp. Date: |
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| Cardholder Name: |
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| Our Federal Taxpayer I.D. # 38-0879125 |
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