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