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Directory Information (to be displayed online) |
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Organization Name * |
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Physical Address 1 * |
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Physical Address 2 |
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City * |
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State * |
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Zip * |
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Organization Phone * |
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Organization Fax |
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Organization Website |
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Organization Email * |
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Main Contact |
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First Name * |
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Last Name * |
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Address 1 * |
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Address 2 |
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City * |
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State * |
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Zip * |
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Title |
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Phone * |
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Email * |
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Billing Address (if different) |
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Street |
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City |
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State |
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Zip |
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Mailing Address (if different) |
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Street |
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City |
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State |
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Zip |
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Additional Information |
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Referred by |
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How did you hear about us? |
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What is your reason for joining?
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The Chamber offers resources and services that focus on the needs of specific types of businesses. In order for the Chamber to best serve your business, please mark the category (if applicable) that best describes your business.
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Membership Information
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Membership Level: *
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Primary Directory Category *
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Number of Full Time Employees:
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Number of Part Time Employees:
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Number of Rooms (Hotels and Motels):
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Number of Beds (Hospitals and Convalescent Centers):
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$
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$
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Total: $
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The contents of this box are for testing purposes. This box will be removed when the form goes live.
Full-Time Employees
Part-Time Employees
Hotel/Motel Rooms
Restaurant Seats
AdditionalCategories
Additional Categories Cost
NumberOfAdditionalCategories
additionalItem1Cost
Annual Dues (charged to card)
Tax (charged to card)
Fee (charged to card)
tempValueForDropDown1
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NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.
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Credit Card Information
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This process uses the latest SSL security encryption.
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Credit Card Type *
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Credit Card Number *
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