Membership Application

Business Name (if joining as an individual, list your name)

Primary Contact: *

Title: *

Email Address: *

Secondary Contact (if applicable):

Title:

Email Address:

Physical Address

Do you want this physical address listed on the Chamber website? *

Yes

Mailing Address

Is your mailing address a private address? *

Yes

Website Address

Secondary Website Address

Contact Numbers

Main Phone Number: *

Toll Free Number:

Alternate Telephone: *

Fax:

Do you want your "alternate number" listed on the Chamber website? *

Yes

Home Based Business: *

Yes

Employees

Number of Full-Time Employees: *

Number of Part-Time Employees: *

Number of Professionals:

Is there someone that we can thank for referring you to the Chatham Chamber of Commerce? *

About Your Business

The "About Your Business" information will be listed on the Chamber website with your listing.

Annual Membership Investment

Please see the Investment Schedule to calculate your annual investment. You will have the option to pay for your Membership Investment using a credit card on the next page.

It is understood that this investment automatically renews itself each year unless written notice of cancellation is received. However, your membership will become null and void in the event of dissolution of the organization or non-payment of membership dues. All membership dues are due by October 1 of each year. We appreciate your membership and look forward to working with you.

Submission of this form serves as authorization of your Chamber Membership. Thank you!

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