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Online Application Form  


 

Individual, Marriage, Family  
and Child Counseling


 

              Business Name

                 Contact Person

                              Address

                                     City

                                  State     

                                       Zip   

                                 Phone 

                         Cell Phone      

                                  Email      

                                     CEO

                             Manager

           Year Business Est.

 Chamber member since   

             Type of business    

      Products or Services       

 Any other information you would like for us to know:

Annual Membership Rates:          

plus one time $15  setup fee for first time or non-continuous 

membership)

 

(please circle box that applies)

What do you hope to gain from your Chamber of Commerce Membership? (Please check appropriate boxes)

 

Individual Membership

(no business benefits)

$50.00 annually

Contacts with local business owners?

1 - 5 Employees

$100.00 annually

Involvement in community affairs?

5 - 10 Employees

$150.00 annually

Access to more business resources

11 - 20 Employees

$200.00 annually

Member Discount/Group Plan benefits?

21 - 50 Employees

$250.00 annually

Increased Credibility?

51 - 75 Employees

$300.00 annually

Sponsorship Opportunities?

76 - 100 Employees

$350.00 annually

Other:

101+ Employees

$400.00 annually

 

Banks and Utilities

$750.00 annually

 

 

 

Please make check payable to:

 

Madison County Chamber of Commerce

177 S. Horry Avenue
Madison, FL 32340


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Copyright 2005 The Greater Madison County Chamber of Commerce