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Membership Application

BUSINESS INFORMATION
Firm Name
Primary Mailing Recipient
Mailing Address
City
State
Zip
Phone
Fax
Business Email
Web site
Number of Full Time Employees
Number of Part Time Employees
Business Classification
(As shown in Yellow Pages) - up to 2		 1
2
Additional $50 each
Download Membership Investment Schedule.
Membership level is based on the number of employees. The following additional fees apply:

  • One-Time Processing Fee $25
    •
    REPRESENTATIVE INFORMATION
    Primary Contact Salutation:
    First Name:
    Last Name:
    Title/Position:
    Email:
    I want to receive updates on Chamber activities by
    Contact 2 Salutation:
    First Name:
    Last Name:
    Title/Position:
    Email:
    I want to receive updates on Chamber activities by
    Contact 3 Salutation:
    First Name:
    Last Name:
    Title/Position:
    Email:
    I want to receive updates on Chamber activities by
    Contact 4 Salutation:
    First Name:
    Last Name:
    Title/Position:
    Email:
    I want to receive updates on Chamber activities by


     
    • Black and VeatchMetcalf BankShawnee Mission Medical CenterSprintACCE Accredited