Membership Application

Please complete the following application. If you have any questions, please contact us!

North Channel Area Chamber of Commerce

"Your Channel to Success!"

Yesenia Doyal

Membership Director

(713) 450-3600

yesenia@ncachamber.com

Details

Company/Individual Name

Phone

Ex. (888) 555-1234

Company Website

Company Email

Preferred Method of Communication

Year Business Established

Full Time Employees

(Closest #)

Part Time Employees (Closest #)

Reason for Joining

Addresses

Mailing Address

Enter Below

Physical Address

Business Categories

Category 1
Category 2

Online Directory Settings

Display in Online Directory
(Must be approved by Chamber)

Business Info
Display Name
Phone
Fax
Online Directory Listing Address
	,


Note Displayed on Initial Website Search (250 characters)
Short Description for Website
Business Logo
Website
Website 2
Email
Facebook
Twitter
YouTube

Primary Representative

Name
Title
Email
Username (email recommended)
Password (Members Only Area)
Confirm Password (Members Only Area)
Use Member Phone	Rep Ph.
Mailing Address
	,


Physical Address
	,

Billing Representative

Primary Rep is Billing Rep
Uncheck if your organization has different primary and billing reps

Membership Dues
Select Membership Level	Small Business with 1-10 employees. Business with 11-50 employees. Business with 51-100 employees. Business with 101-200 employees. Business with 201-300 employees Business with 301-400 full-time employees. Business with 401-500 employees. Business with over 500 employees

Thank you!