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Company Information

Company Name:*

Address:

City: 

 State: Zip: 

Telephone:*

 Fax: 

Website:

# of Employees:

Business Category:

(We use the same business categories as the telephone directory)

Please provide both a short and a long business description for use in Chamber publications and on the website

Short Version: (40 characters including spaces)

Long Version: (15 words)

Employee Information
Please indicate one name you would like printed in Chamber publications

 Primary Contact:

 Title: 

Telephone:

 Email: 

 Company CEO:

 Title: 

CEO Email:

 Marketing Mgr:

 Title: 

Marketing Mgr Email:

 Govt Affairs Mgr:

 Title: 

Govt Affairs Mgr Email:

 Purchasing Mgr:

 Title: 

Purchasing Mgr Email:

Reason for Joining

 Networking & Educational Opportunities   Gov't Advocacy   Benefits & Discounts
 Marketing & Promotion   Community Involvement   Other