Membership Application

(Company Name, Address, Contact Person, Email, Phone # and Website will be listed in the directory unless otherwise noted.)

Company Name(Required)

Owner(Required)

Contact Person(Required)

Business Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Mailing Address

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Toll Free

Cell(Required)

Email(Required)

Web Page

Business Category for Directory

Billing Address (if different from above)

Street Address City State ZIP Code

Accounting Contact Person(Required)

Accounting Phone Number(Required)

Accounting/(Billing) Email Address(Required)

Street Address City State ZIP Code

Type of Business	Annual Dues
General Business /Gov. Agency More than 1 location…. Under 50 Full Time Employee’s add… Over 50 Full Time Employee’s add……	$ 320.00 $ 120.00/additional outlet $ 2.00/each $ 1. 00/each
Licensed Professionals Plus, for each partner add......	$ 320.00 $ 40.00
Hospitals	$ 1,825.00
Medical Facilities	$ 1,220.00
Financial Institutions Additional Branch……	$ 1,035 $ 120.00
Lodging/Retirement/Assisted Living Per bed or unit under 50 add…… Per bed or unit over 50 add…	$ 320.00 $ 2.00/each $ 1.00/each
Personal Membership & Non-Profits….	$ 220.00
Public Utilities, Port, Water Board	$ 1,265.00

Number of Employees or beds/units/branch/partner

Annual Dues

Additional Fees

Total Due

Describe Your Business for the newsletter and publications

YOUR CHAMNBER MEMBERSHIP IS AN INVESTMENT IN YOUR COMMUNITY. THIS INVESTMENT, WHEN REPORTED AS BUSINESS EXPENSE IS DEDUCTIBLE. CHAMBER DUES ARE NOT DEDUCTIBLE AS CHARITABLE CONTRIBUTION FOR FEDERAL INCOME TAX PURPOUSES.

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