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