Today's Date:

Company Name:

Contact Name:

Address:

City:   State:   Zip:

Telephone:   Fax:

Web Address:   Email:

Ceo/Manager Name:  

Title:

No. of Employees:   Date Established:

Description of Business & Services Offered:

What ideas or concerns do you have about the business climate and Chamber of Commerce in the County?

Please Check One:

$50 Associate (Individual without a business)

$125 Small Investor (5 or fewer employees)

$150 Small Business (6-10 employees)

$175 Medium Business (11-19 employees) 

$200 Large Business (20-39 employees)

$250 Manufacturers (40-69 employees)

$300 Major Employers (70-199 employees)

$400 Trustee Members (200-499 employees)

$500 Leader Members (500+ employees)