Marion Area  Chamber of Commerce...presents

APPLICATION FOR MEMBERSHIP

FIRM NAME:

STREET ADDRESS:

P.O. BOX:

CITY:

ZIP:

TELEPHONE:

FAX:

INTERNET WEB PAGE:

E-MAIL ADDRESS:

# FULL TIME EMPLOYEES:

# PART TIME EMPLOYEES:

ANNUAL DUES AMOUNT:

DATE:

ALTERNATE BILLING NAME, IF DIFFERENT FROM PRIMARY PERSON::

ALTERNATE BILLING STREET ADDRESS, IF DIFFERENT FROM PRIMARY ADDRESS::

ALTERNATE BILLING CITY, IF DIFFERENT FROM PRIMARY ADDRESS::

ALTERNATE BILLING STATE, IF DIFFERENT FROM PRIMARY ADDRESS::

ALTERNATE BILLING ZIP CODE, IF DIFFERENT FROM PRIMARY ADDRESS::

THE ANNUAL DUES INCLUDES A $5.00 ANNUAL SUBSCRIPTION TO OUR NEWSLETTER "PROGRESSING TOGETHER."

BUSINESS OWNER/CEO

NAME:

TITLE:

PHONE:

(EXT):

FAX:

E-MAIL:

OTHERS TO WHOM CHAMBER MAIL SHOULD BE DIRECTED

#1

NAME:

TITLE:

PHONE:

(EXT):

FAX:

E-MAIL:

#2

NAME:

TITLE:

PHONE:

(EXT):

FAX:

E-MAIL:

GIVE A BRIEF DESCRIPTION (15 WORDS OR LESS) OF YOUR BUSINESS FOR YOUR FREE LISTING IN THE MEMBERSHIP DIRECTORY.

USING THE TELEPHONE BOOK YELLOW PAGE LISTING AS A GUIDE, IN WHAT CATEGORIES SHOULD YOU OR YOUR BUSINESS BE LISTED.   THIS IS A FREE BENEFIT OF MEMBERSHIP.

#1

#2

#3

#4

#5

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Visitors Bureau  |  Economic Development

Marion Area Chamber of Commerce
205 W. Center St.
Marion, Ohio  43302-3719
740.382.2181 Fax 740.387.7722

Email us at:  phall@marionareachamber.org