Membership Application

Please submit the following application to be considered for membership. You will be contacted by a staff person to complete your application process.

**NOTE:  By submitting this form, you agree and understand that; this contract and payment of memberhip dues entitles you to all the benefits provided by the Chesterfield County Chamber of Commerce, Inc.  Member dues may be tax deductible as an ordinary business expense.  You hereby agree, and understand, that membership (billed annually) is continuous until cancelled by notifying the Chamber in writing.

Firm Name *
Voting Member/Primary Representative * Please enter: Member, Primary, or Mr., Ms., or Dr.
Email Address *
Web Address
Secondary Contact (Mr. Ms. Dr.)
Email Address for Secondary Contact
Physical Address *
City *
State *
Zip *
Phone *
Fax
Mobile
Mailing Address (if different from above)
City
State
Zip
Preferred Communications Method * (Check one)	Contact me by Fax  Contact me by Email  Contact me by Mail
Describe your Business in 5 words or less
Primary Directory Category *
Secondary	Directory Category [x close] [help]
Chamber Sponsor * (who introduced you to the Chamber)
Number of Employees
* bold entries are required