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501(c)(3) Orgs 11+ Employees Sign Up

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Referred By:
Referral Details:
Please list name of person who referred you and their company name here, or note specifics if you answered "other."
Your Company Name:
Physical Address:
City:
State:
Zip:
Are you currently open for business at this address?:
Mailing Address:
City:
State:
Zip:
Phone:
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Ext.:
Primary Contact:
Please enter in Last Name, First Name
Title:
Additional email addresses you would like to have added to our contact list:
Website (add http:// in front of address):
Is your website currently "live"?:
 
Number of Employees:
Business Description:
Would you like to be assigned an Ambassador?:
Ambassadors assist new members in getting involved with the Chamber, introduce them to other members and act as a contact person for any questions or concerns they may have.
Name of person who handles your marketing:
Marketing Rep Email:
Username:
Password:
Please select a password that you will use to access your Directory Page.