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Organization Information (to be displayed online) Organization Name Address 1 Address 2 City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Phone Mobile Phone (For Staff use only)) Fax Website Email Main Contact Copy from Organization-Information Prefix Dr. Mrs. Mr. Ms. First Name Last Name Address 1 Address 2 City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Title Phone Email Additional Contacts Contact 1 First Name Last Name Title Email Address Contact 2 First Name Last Name Title Email Address Add/Remove Contacts Billing Address (if different) Address 1 Address 2 City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Mailing Address (if different) Address 1 Address 2 City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Additional Information What prompted you to join? Please Select One... Spoke with a Chamber staff member Received a Chamber mailing Good business practice Referred/suggested by someone Other If Other, please explain Please tell us the top two reasons you are joining the Chamber Referred By Company Information Number of Full Time Employees Number of Part Time Employees Year Established Membership Investment Membership Type Select one... Connected Level $400 – 30 employees max Engaged Level $600 – 75 employees max Advocate Level $825 - no employee max Impact Level $1,650 - no employee max Champion Level $2,750 - no employee max Elite Level $5,500 - no employee max Primary Directory Category None Accounting Services Acupuncturist Addiction Treatment Administrative Services Adult Daycare Adult Education Advertising Agriculture Air & Water Purification Systems Air Duct Cleaning Aircraft Charter & Management Airport Alarm Companies Alterations Ambulance Services Animal Control Animal Rescue Answering Service Apartments Appliance Delivery / Installation Architects Art Gallery Arts Asphalt / Concrete Contracting Assisted Living ATM (Automatic Teller Machine) Owner / Operator Attorneys Auction / Auctioneer Audio-Visual Autism Services / Developmental Disabilities Auto Detailing Automobile Dealers Automobile Rentals Automotive & Truck Accessories Automotive Services Bakery / Desserts / Favors Banks Banquet / Meeting Facilities Barber Shops Battery Supplies Brewery Bridal Business Consulting Business Financing Business Services and Technology Cabinetry Call Centers Camera / Video Candles Car Wash Cardiac Rehabilitation Carpet - Retail Carpet / Upholstery Cleaning Caterers CDL / Trucking Cellular Chemical Dependency Childcare / Daycare Children's Health Chimney Sweeping Chiropractors Churches Cleaning & Janitorial Services Cleaning & Janitorial Supplies Coffee Shops Coin Dealers Collection Agency College Consulting Commercial / Residential Restoration Commercial Lending Commercial Real Estate Communications - Media Communications - Technology Community Volunteer Computer Repair Computer Support Concrete Leveling Condominiums Consignment Construction Cleaning Construction Distributor Construction Management Construction Services Contract Packing / Packaging Copywriting Cosmetics & Skin Care Counseling Services Courier Credit Card Processing Credit Unions Cremation Services Custom Closets Custom Homes Cyber Security Dance Instruction Data Recovery Deck Construction Decorating Delivery Services Demolition Dentists Dietitian Disc Jockeys Distillery / Spirits Distribution Document Managment Doors & Windows Downsizing / Decluttering Driving School Dry Cleaners E-Commerce Education Educational Childcare Electrical Contractor &/Or Supplies Embroidery / Screenprinting Employee Assistance Programs Employee Benefits Employee Fraud Detection Employee Safety Services Employee Wellness Benefits Employment Services Engineers Entertainment Environmental Services Estate Planning Event Planning Event Rentals & Enhancements Event Venue Excavating Eye Care Medical Practice Fence Sales & Installation Filters - Industrial and Residential Financial Planning Services Financial Services Fire / Chimney / Fireplace Safety Fireplace - Sales / Service Fishing / Professional Angler Fitness Centers Flea Market Floor Care Flooring - Retail Florists Food Ingredients Food Pantry Food Trucks Foot Care Foster Care Foundation Repair / Waterproofing Framing & Art Franchise Consulting Fuel / Propane Supplier Funeral Homes / Services Furniture Stores Garage Doors Garbage / Trash Services Garden Centers & Nurseries Gasline Repair and Installation General Contractor Gifts Golf Academy Golf Courses Golf Equipment Gourmet Beverages Government Agencies Granite Countertop Fabrication Grant Writing Graphic Design Gravel/Sand Greenhouse Grocers - Retail Gutter Cleaning Hair Removal Hair Salons & Spas Handyman Services Hardware Health and Wellness Health Screenings Healthcare Healthcare - Outpatient Rehab. Healthcare Management Hearing Services Heating & Air Conditioning Higher Education Holistic Home / Facility Maintenance Services Home Builder Home Furnishings Home Health Care / Home Care Home Improvement Home Improvement Store Home Inspections Home Medical Equipment Home Organization Homeowners Association Horse Boarding and Lessons Hospice / Palliative Care Hospitals Hotels Human Resource Consulting & Outplacement I.T. Consultants Ice Cream / Frozen Yogurt Identity Theft Service Plans Image Consulting Imaging Services Immigrant Services Infrastructure & Data Insurance Interior Design Internet Service Provider Inventory Professional Irrigation and Sprinkler Systems Jewelers Jewelry Buyers Kennel Lab Tests Land Surveying Landscaping Language Services Law Firms Lawn & Farm Equipment Lawn Care Legal Service Plans Legal Services Libraries Limousine Services Liquidation Liquor Stores Locksmith Machining Mailboxes and Posts Mailing Technologies Manufactured Housing Manufacturing Manufacturing Representative Marketing Marketing Research Martial Arts Massage Therapy Mattresses Mechanical Contracting Media Media & Marketing Consulting Medical Medical Billing Medical Collections Medical Device Medical Laboratories Medical Offices Memory Care Men's Clothing Mental Health Services Metal Recycling Micro Loans / Microlending Military Mold Remediation / Removal / Testing / Inspection Monuments & Memorials Mortgages Motorcycle Sales & Services Moving & Storage Music Performers Musical Instruments/Instruction Nail Salons Natural Gas Newspapers Nursing Homes Nutrition Consulting Occupational Health Office Equipment/Supplies Office Furniture Office Space Online Computer Software Optical Optometrists Organizations Orthodontics Orthopedic Care Painting Parking Lot Maintenance Payroll Services Personal Chef Personal Training Pest Control / Exterminator Pet Services Pet Waste Removal Photography Physical Therapy Physicians Pipe, Valves, Fittings Piping Contractor Plastic Surgery Plumbing Pressure Washing Contractor Printing Professional Employer Organization Professional Training Promotional & Printed Products Property Management Services Prosthetics/Orthotics Public Relations Publications Radio Stations Real Estate Real Estate Development Real Estate Inspection Real Estate Investments Recycling Services Rehabilitation and Skilled Nursing Rehabilitation Clothing & Products Remodeling Renewable Energy Rental Equipment Residential Real Estate Residential Restoration Restaurant Equipment Sales and Service Restaurants Retail Retirement Community Roofing Sales Satellite School Corporations Scrapbooking Security and Fire Companies Send Out Cards Distributor Senior Services Shipping & Business Center Signs & Banners Snow Removal (Commercial & Residential) Social Services Special Events Sports Teams and Clubs Storage-Self Service Studio Kitchen Surgeons Surveyors Swimming Lessons Swimming Pool Services Tanning Salons Tattoo Tax Services Technology Services Telecommunications Tent Rentals Theatre Tile and Flooring Tires Title Insurance Tool Distribution Tourism Translators and Interpreters Transportation Travel Agencies Trophies/Plaques/Awards Truck Repair & Service Uniforms / Apparel / Mats Utilities Vacation Planning & Honeymoon Vein Clinic Venture Capital Firms Veterinarians Video Production and Duplication Warehouse Water and Fire Restoration Water Conditioning Water Heating Wealth Management Weather Web Development Website Wedding Weight Loss Program Window Cleaning Window Treatments / Drapes / Blinds Winery Wireless Women's Clothing Yoga Additional Directory Categories Select additional directory categories below by holding the "CTRL" key Secondary categories may be subject to additional fees none Annual Membership Investment One-Time Application Fee Total The contents of this box are for testing purposes. This box will be removed when the form goes live. Additional Items Additional Categories Cost Tax Number of Rooms Number of Seats Number of Associates Number of Locations Millions in Assets Full-Time Employees Part-Time Employees Hotel/Motel Rooms Restaurant Seats Additional Associates Additional Associates Cost Additional Locations Additional Locations Cost Assets Assets Cost Additional Categories Number Of Additional Categories Additional Categories Cost Additional Item 1 Cost Additional Item 2 Cost Additional Item 3 Cost Additional Item 4 Cost Additional Item 5 Cost Additional Item 6 Cost Additional Item 7 Cost Additional Item 8 Cost Additional Item 9 Cost Additional Item 10 Cost Annual Dues (charged to card) Revenue Item Tax (charged to card) Fee (charged to card) Temp Value For DropDown 1 MembershipType Additional Item 1 Additional Item 2 Additional Item 3 Additional Item 4 Additional Item 5 Additional Item 6 Additional Item 7 Additional Item 8 Additional Item 9 Additional Item 10 Payment Type Credit Card Check NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks. Credit Card Information Copy from Organization Information Credit Card Type MastercardVisaAmex Credit Card Number Name on Card Security Code Valid Through 01 02 03 04 05 06 07 08 09 10 11 12 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 Address City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Phone Credit Card Email Address Please click submit only one time. The transaction may take several seconds. Please select a membership type before submitting your application.