Member Application – Wakarusa Chamber of Commerce

Company Name: *

Contact Person: *

First

Last

Title:

Address: *

City / State / Zip: *

(uncheck if billing address is different and fill out fields below)

Billing Address:

Billing City / State / Zip:

Phone: *

Fax:

Email *

Web Site Address:

Type of Business *

Number of Employees (Full Time) *

Number of Employees (Part Time)

Number of Employees (Seasonal)

Dues Investment *

*Additional $25.00 fee per year for those outside Elkhart County

Check Number *

Brief History of your business:

Brief 25 word description of your products and/or services to be listed on website:

Special characteristics of your business:

Hopes and dreams for your community and business:

What can the Chamber do for you?

Would you like the Chamber to host a ribbon cutting ceremony? *

Website

Membership Application