Join the Chamber
Name of Business
Name of Chamber Representative:
First: MI: Last: Mailing Address: P.O. Box: Street: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming Zip Code: Location: Street: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming Zip Code: Date Business Started: 01 02 03 04 05 06 07 08 09 10 11 12 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 Before 1985 Type of Business: Choose Category Academic/ Educational/ Training Advertising /Media Agriculture Attorney Automotive Civic/ Church Construction Designs/ Printing/ Signs Entertainment Financial Floral/ Lawn Care/ Nursery Government Grocers Healthcare Home Repair Hotel Insurance Locksmith Mortuary Other/ Individual Photography Real Estate Restaurant Retail/ Gift Veterinary Name of Owner/ Manager: First: MI: Last: Phone Number: Fax: E-mail: Web site:
First: MI: Last:
Mailing Address:
P.O. Box: Street:
City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming Zip Code:
Location:
Street:
Date Business Started: 01 02 03 04 05 06 07 08 09 10 11 12 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 Before 1985
Type of Business: Choose Category Academic/ Educational/ Training Advertising /Media Agriculture Attorney Automotive Civic/ Church Construction Designs/ Printing/ Signs Entertainment Financial Floral/ Lawn Care/ Nursery Government Grocers Healthcare Home Repair Hotel Insurance Locksmith Mortuary Other/ Individual Photography Real Estate Restaurant Retail/ Gift Veterinary
Name of Owner/ Manager:
Phone Number: Fax: E-mail:
Web site:
Membership Dues Please check one: 1-5 employee $50.00 6 or more employees. $75.00 Non-profit/church/civic. $35.00 Second business/same owner $35.00 Individual $35.00 New Member Renewal
Membership Dues Please check one:
New Member
Renewal
By submitting this form you consent to being e-mailed and faxed regarding Chamber events and issues.
Please print and mail check or money order to:
101 S.E. Central Ave. Amite, LA 70422