Membership Application Form

Membership Name________________________________________________________

Mailing Address__________________________________________________________

Billing Address________________________ Physical Address_____________________

City___________________ State__________________ Zip Code___________________

Phone #_________________________________ Fax # ___________________________

Web Address____________________________ E-Mail Address___________________

Primary Contact Name ________________________________ Title ________________

Secondary Contact Name _______________________________Title________________

Number of Employees ____________ Classification of Business ___________________

Additional Listings 1_________________________2_____________________________

I hereby apply for membership in the Artesia Chamber of Commerce agreeing that my annual investment will be $__________ payable as indicated below.   

(   ) Annually  (   ) Semi-Annually     Billing Method: (   ) Check Attached    (   ) Invoice

Signature _____________________________________Date ____________

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Ribbon Cutting _______________________________ Door Decal__________________

New Member Newsletter ______________________ Bookkeeper __________________

Thank you, for your community investment.