Member

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Directory Category: *

Employees: *

Full-time Part-time

Comments / Questions:

What prompted you to join the chamber of commerce?: *

Did a member refer you to the Apex Chamber?: *

If yes, who?:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Social Networking:

LinkedIn Facebook

Primary Contact Information

First Name: *

Last Name: *

Phone: *

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Phone: *

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Membership Level: 1 - 10 Employees: $315.00
Membership Level: 11-30 Employees: $420.00
Membership Level: 31-50 Employees: $525.00
Membership Level: 51-100 Employees: $735.00
Membership Level: 101-149 Employees: $1,260.00
Membership Level: 150+ Employees: $2,100.00
Membership Level: Financial Institution: $815.00
Membership Level: Non-profit 501(c)(3): $200.00
Membership Level: Individual - Not representing a business: $130.00
(Student/Retiree)

Payment Option:

Charge my credit or debit card

Member Application

Mailing Address

Address

Address