2015
LPCC CHAMBER OF COMMERCE MEMBERSHIP APPLICATION

Required fields are marked with *
       
BUSINESS INFORMATION    
       
*Company Name *Phone #
Company Website FAX #
* Company Email Toll Free #
Alternate #    
*Physical Address    
*City *State *Zip
 
Mailing Address
(If different from above)
   
City State Zip
       
PRIMARY REPRESENTATIVE (PRESIDENT/CEO/OWNER)    
       
*Name *Title
*Email *Phone
Cell/Alternate Phone Fax
Direct Phone    
Address
(If different from above)
 
City; State Zip
       
BILLING CONTACT    
       
*Name *Title
*Email Phone
Cell/Alternate Phone Fax
Direct Phone    
Address
(If different from above)
 
City State Zip
       
ADDITIONAL REPRESENTATIVES    
       
Name Title
Email Phone
Cell/Alternate Phone Fax
Direct Phone    
Address
(If different from above)
 
City State Zip
       
MEMBERSHIP INVESTMENT    
       
Annual membership dues are based on the Chamber benefit level chosen by the company as listed to the right:
(Please check one)



• Complimentary attendance to quarterly networking meetings
• Discounted special event tickets (Luncheon & Gala)
• Included in church directory- listed by business name and contact info
• Booth opportunities for $50



• Complimentary attendance to quarterly networking meetings
• Discounted special event tickets (Luncheon & Gala)
• Included in church directory & newsletter
• Booth opportunities for $25

• Complimentary attendance to quarterly networking meetings
• Complimentary special event tickets (Luncheon & Gala)
• Included in church directory & newsletter with picture
• Complimentary booth opportunities
• Featured in monthly highlighted business
       
COMPANY PROFILE    
       
  Please identify the appropriate business sector(s) for your firm. Please select 2 categories that apply.
Choice 1 Choice 2


If Other:


If Other:
       
  KEYWORDS (30 CHARACTER MAX. LENGTH)  
 
 
 
 
       
  Please list days and hours of operation    
       
    Open Close  
  Sunday  
  Monday  
  Tuesday  
  Wednesday  
  Thursday  
  Friday  
  Saturday  
       
  Number of Full Time Employees:    
  Number of Part Time Employees:    
       
  Please use the space below to provide a brief description of your company that may be used in your profile.  
 
 
 
  Once you have submitted your application you will be redirected to a new page to make your payments.
     

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