Pierceton Chamber of Commerce Membership Request Form
Please fill in the form below.
Date
*
-
Month
-
Day
Year
Full Name
*
Prefix
First Name
Last Name
Entity Name:
*
This is how it will be listed on the website as who is present
Mailing Address
*
Street Address
P.O. Box Number
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Facebook Page:
*
Yes
No
Website:
*
If none, mark as N/A
Preference on hyperlink on our website to your:
*
Facebook Page
Website
Type Of Business or Organization:
*
Retail
Service
Manufacturing
Government
Church
Organization
Please select from the list
Brief description of business or organization:
*
Limited to 30 characters
Number of Years in Service
*
Type a Numeric Value
Number of Full Time Employees
*
Type a Numeric Value
Any other information you want us to know?
Annual dues are based on the number of employees. All businesses and individuals have full voting privileges with one vote placed per member entity.Individual dues $35 per year.Businesses with under 10 employees, $50 per year.Businesses with over 10 employees, $100 per year.
Please email me an invoice for processing at the above email address
I will mail my payment to: Pierceton Chamber of Commerce P.O. Box 49 Pierceton, IN 46562
**All memberships are due on January 1 and will expire on December 31**
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