Number of Employees
(Note: Two part time employees 
equal one full time employee)

Membership 
Fee

Address:           

City:    State:   Zip:

Owner Name:          

Local Contact Name:

Local Contact Phone:

Local Contact Fax:    

Local Contact Email: 
Web Site:                 

In the box below please provide us with a  description of Products/Services you provide:  

Total Number of Employees:

Category from below list:

Number Part Time:   Number Full Time:
Year Business Established   
Chamber Member Since     

Your email address or fax is used to keep you updated of chamber meetings and upcoming events.  If you do not wish for this information to be published in our annual directory, please check the box below:

Note: Please return this application along with your payment to the above address.  If you are renewing your membership from last year, or if you are a non-profit organization, please complete this application in full, so that we may update our records.

FOR OFFICE USE ONLY______________