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New Member Application
(*) Denotes Required Fields
Company Information
Company: *
Address Line 1: *
Address Line 2:
City: *
State: *
Zip: *
Phone 1: *
Phone 2:
Fax:
E-mail: *
Web Site:
Online Links:
Business Category #1:
Please contact us with questions regarding business categories.
Full-time Employees:
Part-time Employees:
Members-only Access
Members-only allows you to update your information online via a secure login.
Admin E-mail: *
Password: *
Verify Password: *
Primary Contact Person
Prefix:
First Name: *
Last Name: *
Suffix:
Familiar Name:
Title:
Address Line 1: *
Address Line 2:
City: *
State: *
Zip: *
Phone 1: *
Phone 2:
Fax:
E-mail: *
Billing Contact Person
Prefix:
First Name: *
Last Name: *
Suffix:
Familiar Name:
Title:
Address Line 1: *
Address Line 2:
City: *
State: *
Zip: *
Phone 1: *
Phone 2:
Fax:
E-mail: *
Investment Schedule
Two part-time employees count as one full-time employee.
Annual Investment:$150.00
Number of EmployeesAmount
1 thru 5$150.00
6 thru 10$200.00
11 thru 25$250.00
26 thru 50$350.00
Over 50 Employees$500.00
__________
Total:$0.00
I/We hereby subscribe to membership in the Decatur Chamber of Commerce, accepting the membership category to which I have been assigned, and promise to pay annual dues in the amount designated (and as may be periodically revised by the Board of Directors), payable annually.
(*) Denotes Required Fields

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