Membership ApplicationMembership Application Business Name*Address Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Physical Address (If Different)PhoneFaxWebsiteCompany E-mailDate Company Established# of Full Time Employees# of Part Time EmployeesPrimary ContactTitleContact E-mailContact PhoneBusiness ClassificationThis category will be used for your listing in the Chamber's Membership Directory and Website.Under what specific category is your business listed in the Yellow Pages?Please share with us your reason(s) for joining the Chamber. What are your expectations?Choose Your Membership Level*Terms: A processing fee of $25.00 is required with this application. Investments are continuous unless canceled in writing. Investments may be 96% tax deductible as a necessary business expense, but are not deductible as a charitable contribution.Executive Membership $5,105 (Member Investment $5080 + $25 one-time admin fee)Keystone Membership $2,305 (Member Investment $2,280 + $25 one- time admin fee)Premier Membership $910.00 (Member Investment $885.00 + $25 one time admin fee)Entrepreneur Membership $615 (Member Investment $590 + $25 one - time admin fee)Classic Membership $295 (Member Investment $295 + $25 one- time admin feeOut of Town Membership $295.00Associate Membership $210.00Senior Booster $130.00Senior Booster Members Only Yes! Add my spouse to my Senior Booster Membership.Additional Chamber Representatives Yes! I would like to add additional Chamber Representatives, above what is included in my base membership.Acknowledgement of Terms* I agree that I have read the terms listed at the top of this page. I understand that upon completing the payment process, I have entered into a membership agreement with the Emporia Area Chamber of Commerce.Digital Signature*By typing my name in the following box, I hereby acknowledge that I have read and understand the Money Back Guarantee and that all information entered on the application is true and correct. My typed name above represents my signature. First Last PaymentTotal $0.00
