| Organization: *
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| Type of Business: * |
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| Address: *
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| City: *
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| State: *
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| Zip Code: *
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| Phone: *
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| Fax: |
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| Website: |
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| Company Email: |
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| Full Time Employees: |
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| Part Time Employees: |
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Main Contact Information |
| Contact First Name: *
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| Contact Last Name: *
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| Main Contact Address: |
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| Main Contact City: |
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| Main Contact State: |
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| Main Contact Zip: |
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| Main Contact Phone: |
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| Preferred Method of Communication |
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Email |
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Fax |
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US Mail |
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| Do any of the following special interest groups apply? |
Small Business |
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Home Based |
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Woman Owned |
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New Business |
| Are you interested in more information about? |
Group Health Insurance |
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Worker's Compensation |
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Relocation Inquiries |
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| Create a 350-character business description: |
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| Why are you joining? |
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Legislative & Political Action |
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Support of the chamber and its work |
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Networking opportunities |
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Workers Compensation discount |
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Ribbon Cutting |
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Advertising/marketing opportunities |
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Medical insurance |
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Referral services |
Membership Investment |
| Part time staff is counted as 1/2 so 2 PT employees = 1 employee |
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| Annual Dues: *
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| Processing Fee: |
A one-time processing fee of $40.00 will be charged with your application. |
| Additional Categories: |
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| Total: |
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Payment Information |
| PaymentType
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Credit Card Number
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