Clinton Area

Chamber of Commerce

Membership Application

Date

Business Information

Business Name
Business Mailing Address
Street Address
	If different from mailing address
City		State			Zip
Phone		Fax			E-mail
Website Address
Year Business Began				Type of Business
Number of Employees (full time & part time)			FT			PT

Contact Information

Main Contact Name

Position/Title

E-mail address

Additional Contacts:

Name
Position/Title
Address
E mail address	Phone
Name
Position/Title
Address
E-mail address	Phone

Payment Information

Annual (1 payment)

Semi-Annual (2 payments)

Free 25-word Profile of Your Business Featured in the Chamberπs Monthly Newsletter

All new members receive a free 25-word profile in the Chamberπs monthly newsletter. Please describe what you most want members to know about your business. Please limit this to 25 words or less.

Additional Information You Would Like to Tell the Chamber About Your Business