Application

Business Information (to be displayed online)

Business Name

Address 1

Address 2

City

State

Zip

Phone

Fax

Web Site Address

Facebook Address

Business Description for Promotional Purposes

Main Contact

First Name

Last Name

Address 1

Address 2

City

State

Zip

Title

Phone

Associate Member Name(s) OPTIONAL
Please provide associate member names and mailing addresses (if different than above). Associate members are individuals within your company/organization who, in addition to the Main Contact, will receive all print and electronic communications from the Chamber. The annual dues amount for an Associate member is $60.

Additional Contacts
Additional contacts can be established at your organization for no additional fee. These individuals will receive electronic communications only from the Chamber.

Billing Address (if different)

Address 1

Address 2

City

State

Zip

Mailing Address (if different)

Address 1

Address 2

City

State

Zip

Additional Information

Referred By

How did you hear about us?

What is your reason for joining?

Please have someone contact me regarding

Programs to increase our organization's visibility in the marketplace
Programs to save our organization money on operating costs
Programs to enhance our organization's employee development and decision making
Other Required Please enter a valid number Please enter a valid date

Membership Investment

All membership applications submitted should be accompanied by your first calendar year investment payment. New membership applications must be approved by the Chamber President and Vice President before being finalized. Contributions, gifts, and dues to the Sidney-Shelby County Chamber of Commerce are not deductible as charitable contributions for federal income tax purposes.

Membership Type

Primary Directory Category

Additional Directory Categories

Select additional directory categories below by holding the "CTRL" key

Number of Associate Members

Annual Membership Investment

PRORATED FEE - If joining during a membership year, divide the total payment by 12 and multiply by the number of months remaining in the year. Membership year runs January to December.

Today's Date: Date Loading...

Prorated Investment

Application Fee (One Time)

Total

The contents of this box are for testing purposes. This box will be removed when the form goes live.

Full-Time Employees

Part-Time Employees

Hotel/Motel Rooms

Restaurant Seats

Additional Associates

Additional Associates Cost

Additional Locations

Additional Locations Cost

Assets

Assets Cost

Additional Categories

Number Of Additional Categories

Additional Categories Cost

Additional Item 1 Cost

Annual Dues (charged to card)

Revenue Item

Tax (charged to card)

Fee (charged to card)

Temp Value For DropDown 1

MembershipType

Payment Type

NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.

Please click SUBMIT only one time. After, you will receive a pop up message that reads, Are you sure you want to save this information? CLICK OK. The transaction may take several seconds.

A Chamber representative will follow up to confirm acceptance of your application for membership.

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Application