MEMBERSHIP APPLICATION

Firm Name ________________________________________________

Firm Address______________________________________________

Mailing Address ____________________________________________

City/State/Zip ______________________________________________

Type of Firm _______________________________________________

Contact/Title ______________________________________________

Website Address ___________________________________________

No. of Employees Full Time Part Time Temporary _ __ _____

Telephone _________ ____ ____ Toll Free __________ ___ ____

Fax __________ ___ E-Mail __

We want to know why you want to join the Chamber so that we can assist you in taking advantage of the benefits of Chamber membership. Please indicate your level of interest in each of the following activities by numbering them from 1 through 5. (1 indicates your highest priority and 5 indicates your lowest priority.)

____ Networking/Business Contacts ____ Advertising/Business Promotion

____ Business Support Programs ____ Professional Development

____ Local/State Government Affairs ____ Economic Development

____ Community Activities ____ Tourism

____ Chamber Organization ____ Chamber Publications

This application is for Chamber membership commencing in ____ with annual dues payable each year. By signing below, you agree to abide by the terms of the Chamber’s by-laws and all the rules and regulations that the Chamber may now or hereafter adopt. Return this completed application along with your check for the first year’s annual dues to Fortville/McCordsville Area Chamber of Commerce, P.O. Box 55, Fortville, IN 46040.

Annual Dues Schedule

Full Member (1-10 employees) $60.00

Full Member (11-25 employees) $84.00

Full Member (26-50 employees) $120.00

Full Member (50+ Employees) $168.00 + $3.60 per each over 51 (Maximum $300)

Not-for-Profit Organizations $30.00

1-time application fee of $30

Date: _ __ Applicant Signature