Los Molinos Chamber Membership Application

Los Molinos Chamber Membership

Please fill in the form below and click submit. Then pay the appropriate dues by using 1 of the 2 options at the bottom of this application.
Business Name
Contact Name *

Prefix First Name Last Name
Type of Business
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Physical Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Business Number

Area Code Phone Number
Cell Number

Area Code Phone Number
Fax Number

Area Code Phone Number
E-mail
Website URL
Date Established

Month Day Year
Date
Number of Employees
Please highlight your business for the Chamber Website?
What would you like to see the Chamber so in the community?
What committees would you like to be involved in?

Chamber Mixer Community Clean-Up 4th of July Activities Fireworks Sales Fund Raising Intern/Scholarship Program Mayor's Race Membership Installation Dinner Tailgate Food Giveaway
Signiture

Clear
Annual Membership Dues are $50.00 for Businesses, $40.00 for Non-Profits and $35.00 for Individuals.

Dues are accepted:

1. Paypal Button on this website

2. Check to:Los Molinos Chamber of Commerce, PO Box 334, Los Molinos, CA 96055o edit this text...

*Members are encouraged to promote your business or organization with
photos, and business highlights. Please include with your application or e-mail.
Should be Empty:

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