Madison County Chamber of Commerce Business Membership Application

Please fill out the following form to apply to be a member with the Greater Madison County Chamber of Commerce. Membership benefits include featured listings on our website and more!

Contact Name(Required)

First MI Last

Date(Required)

MM slash DD slash YYYY

Business / Organization Name(Required)

Mailing Address(Required)

Street Address City ZIP Code

Email(Required)

Website

Office Phone(Required)

Cell Phone

Fax

Preferred Payment Method(Required)

DO NOT Provide your credit or debit card information on this form.

Description of Products / Services Offered(Required)

Additional Information About You or Your Business(Required)

What Goals Can We Help You Achieve?(Required)

Annual Membership Rates(Required)

1-5 Employees ($110)

6-10 Employees ($165)

11-20 Employees ($220)

21-50 Employees ($275)

51-75 Employees ($330)

76-100 Employees ($385)

100+ Employees ($440)

Banks & Utilities ($550)

Churches & Nonprofits ($55)

Membership Goals(Required)

Business Contacts & Networking

Advancing Business Issues

Event Sponsorship

Seminars (Presenting / Attending)

Community Projects

Type of Business(Required)

Please Explain Your Business(Required)

Authorized Individual Name(Required)

First Last

Consent(Required)

You agree that you have authority to make these decisions for the aforementioned business entity.

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