Member - #MICRONET_HEADING# – Willits Chamber of Commerce

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (500 char max): *

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words): *

Comments / Questions:

Name of additional company representative:

Additional company representative email:

How long have you been in business?:

How did you hear about the Chamber?:

Main reason for joining the Chamber?:

Would you like information about participation in Chamber committees?:

Would you like information about sponsoring/advertising opportunities?:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Social Networking:

LinkedIn Facebook Instagram Twitter Pinterest

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook Instagram Twitter Pinterest

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook Instagram Twitter Pinterest

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Basic Membership: See fee schedule to determine the fee and enter it below.
Basic membership includes online directory and community app listing, networking and promotional opportunities, professional development opportunities, marketing materials displayed at Chamber office, members only discounts and pricing, job postings and hot deals. Enhanced Membership: $1,500.00
Enhanced membership includes all benefits of Basic membership plus enhanced online directory and community app listings including the ability to add videos. Premier Membership: $2,500.00
Premier membership includes all benefits of Basic and Enhanced membership plus Gold level sponsorship for the annual Community Festival &Car & Bike Show, VIP seating and parking at events (as available), invitation to VIP events, complimentary table exhibit at one mixer per year. President's Circle: $5,000.00
President's Circle membership includes all benefits of Basic, Enhanced and Premier membership plus company logo on banner in Chamber office and at all Chamber events, prominent ad placement on Chamber's homepage, Platinum level sponsor for all Chamber sponsored events, invitation to President's Circle reception. Public acknowledgement at all Chamber events. Limited number of President's Circle memberships available. If using fee schedule, enter fee here:

Additional Fees:

Application Set-up Fee : $20.00
One-time fee for membership set up.

Payment Option:

Bill me Charge my credit or debit card

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