Membership Form   Please provide the following contact information. *Please use the tab key to move through this form. First Name Last Name Middle Initial Title Organization Street Address Address (cont.) City State Zip/Postal Code Work Phone Home Phone FAX E-mail Web address Top of the page Would you like to be on our email list? We only use email to notify you about Chamber events.  Yes No Please give us your most constant email address (we care about trees and we use email instead of paper mailings). Contact person and title (will be included in our online Chamber directory). How many employees do you have (include yourself - the owner - in this number)? If you have a store front or office outside your home you are not considered a home based business. Student 0 Home based 1-2 3-5 6-10 11-15 16-25 26-50 51-75 76-100 101-150 151-200 201-300 301-400 401-and up Amount you are paying? $0.00 at this time, I need more information. $100.00 for Students & Community Citizens $200.00 for Home based/Retirees $250.00 for 1-2 employees $275.00 for 3-5 employees $300.00 for 6-10 employees $400.00 for 11-15 employees $500.00 for 16-25 employees $600.00 for 26-50 employees $700.00 for 51-75 employees $800.00 for 76-100 employees $900.00 for 101-150 employees $1000.00 for 151-200 employees $2000.00 for 201-300 employees $4000.00 for 301-400 employees $7000.00 for 401 and above employees $10,000.00 Sustaining Partner ONE-TIME Set-up Fee (in addition to Membership Dues). This pays for your membership plaque and name badge. If you need additional name badges they are $10.00 each (just add $10.00 to your total and we'll take care of the rest). $45.00 Chamber membership list (You must be a full dues paying member to receive this list -  sent in Excel spreadsheet). $45.00 Top of the page   Do you want a Ribbon Cutting, Open House or Ground Breaking for your new business? (Free to Chamber East members)  $499.00 (if not a member of one of our Chambers - FREE to members who sign up for regular membership)   Please list at least 2 dates you'd like to have the Ribbon Cutting or Open House Payment Total (with Membership Set-up Fee included). Please select your committee interest. Best of the East Ambassadors Chamber East Green Committee Business Development Economic Development Education Committee Government Action Health Care Committee Membership Committee Networking Groups Special Events How did you hear about us?  (Please check all that apply) Email Friend Internet NxLevel Class SCORE SBA Other Chamber Other Please tell us who referred you so that we can reward them   Top of the page   After you click the "Submit Form" button you will see a confirmation page. On that page you will find the link to make your payment.

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