Online Membership Application

Company Information

Company:

Address Line 1:

Address Line 2:

City:

State:

Zip:

Phone 1:

Phone 2:

Fax:

E-mail:

Website:

Bus. Category 1:

Bus. Category 2:

$20.00

Established Date:

Full-time Employees:

Part-time Employees:

Business Description:

Character Limit: 0/500

Logo:

Images must be less than 1MB in file size.

Image size may not exceed 1MB.

Create Member Account Login

Your member account allows you to update your information online via a secure login.

Admin E-mail:

Password:

Verify Password:

Contacts

Primary Contact

Prefix:

First Name:

Last Name:

Suffix:

Familiar Name:

Title:

Create Login

Your member login allows you to update your information online and register for events.

Username:

Password:

Verfiy Password:

Use Company contact information

Billing Contact

Send invoices to Primary Contact

Investment Schedule

General Business Partner

Two part-time employees count as one full-time employee.

# Employees

Annual Dues

1-25

$200.00

26-50

$350.00

51-75

$600.00

Over 75 Employees

$850.00

$200.00

Individuals not affiliated with a business

$100.00

Non-Profit Organizations

$100.00

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.

Security Code:

Please enter the security code above.