Community Chamber of Commerce Membership Application

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Membership Application

* Required Fields

Company Name: *

Date Firm Established:

Mailing Address: (City, State, Zip+4) *

Physical Address: (City, State, Zip+4)

Phone: *

Additional Phone:

Fax: *

Email Address: *

Website Address:

Owner or Primary Officer: Mr. Mrs. Ms.	Title:
Contact Person to Receive Mail: Mr. Mrs. Ms.	Title:
Person to Receive Billing: Mr. Mrs. Ms.	Title:

Number of Employees:

Full-Time:

Part-Time:

Business Category:

I understand that by providing a fax number and email address, on behalf of the company/organization or individual specified above, I am authorized to and hereby consent for the company/organization or individual to receive faxes and emails sent by and or on behalf of the Community Chamber of Commcerce of East Montgomery County.

Annual Membership Investment Level

The chamber accepts cash, check, or credit card.
To submit credit card information, please contact the chamber.

	Platinum: $2,500 Primary contact plus 8 additional representatives Preferred listing on all Chamber publications		Business: $200 Primary contact only receives information
	Diamond: $1,500 Primary contact plus 6 additional representatives		Non-Profit Organizations: $75 501c3 Designated Organizations, Public Schools and Colleges
	Gold: $1,000 Primary contact plus 4 additional representatives		Individuals: $75 Individuals only - no business name will be associated with this membership
	Silver: $750 Primary contact plus 3 additional representatives		Associates: $100 For business with more than one location in the area. Each additional branch or location can be listed and receive information at each respective address.
	Bronze: $500 Primary contact plus 2 representatives

Dues are deductable as a business expense, not as a charitable contribution.