The Chamber Membership Contact Information Update

(*) Indicates Required Fields * Company/Organization Name: C/O Doing Business As: (if not the same as C/O Name) * Physical Address: * City: * State: * Zip: * Phone: Web-site address: (to be linked on Chamber web-site FREE to Chamber members) Billing   Mr. Mrs. Ms. Dr., etc: * Name: * Billing Address: * City: * State: * Zip: Brief description of C/O mission and activities Year C/O Began Business Year C/O Joined Chamber     Number of Full Time Employees Number of Part Time Employees     If Minority Owned Business, please mark:   African American: Hispanic: Asian: Female: Other: Are you a manufacturer? Yes No If yes, NAICS code: Organization specialty: Chamber members receive informative publications and event updates throughout the year. The number of subscriptions a member will receive is based on the following criteria: 1-20 employees receive two (2) subscriptions to all Chamber mailings 21-50 employees receive three (3) subscriptions to all Chamber mailings 51-100 employees receive four (4) subscriptions to all Chamber mailings 101 + employees receive five (5) subscriptions to all Chamber mailings Home-based businesses receive one (1) subscription to all Chamber mailings Agent/Broker receive one (1) subscription to all Chamber mailings Additional mailings are available for $45.00 per person One (1) contact is required   *Contact Information #1:   Mr. Mrs. Ms. Dr., etc: * Name: Informal Name: * Title: Birthday: Mailing Address: (if different from C/O mailing address) City: State: Zip: * Phone: Fax: Cell Phone: * E-mail: Administrative Assistant:   Name: Phone: Fax: E-mail: Contact Information #2:   Mr. Mrs. Ms. Dr., etc: Name: Informal Name: Title: Birthday: Mailing Address: (if different from C/O mailing address) City: State: Zip: Phone: Fax: Cell Phone: E-mail: Administrative Assistant:   Name: Phone: Fax: E-mail: Contact Information #3:   Mr. Mrs. Ms. Dr., etc: Name: Informal Name: Title: Birthday: Mailing Address: (if different from C/O mailing address) City: State: Zip: Phone: Fax: Cell Phone: E-mail: Administrative Assistant:   Name: Phone: Fax: E-mail: Contact Information #4:   Mr. Mrs. Ms. Dr., etc: Name: Informal Name: Title: Birthday: Mailing Address: (if different from C/O mailing address) City: State: Zip: Phone: Fax: Cell Phone: E-mail: Administrative Assistant:   Name: Phone: Fax: E-mail: Contact Information #5:   Mr. Mrs. Ms. Dr., etc: Name: Informal Name: Title: Birthday: Mailing Address: (if different from C/O mailing address) City: State: Zip: Phone: Fax: Cell Phone: E-mail: Administrative Assistant:   Name: Phone: Fax: E-mail:     | Back to Top |