Member

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max): *

Directory Category:

Employees: *

Full-time Part-time

Business Keywords (enter a space between words):

Comments / Questions:

Referred By:

How did you hear about the PL Chamber?:

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 Twitter Instagram

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook Twitter Instagram

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

Login: *

Password: *

Social Networking:

LinkedIn Facebook Twitter Instagram

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Membership Package: *

Sole Proprietor: $225.00
Sole Proprietor Non Profit Organization: $150.00
Non Profit Organization 1-5 Employees: $325.00
2 Part-time employees= 1 Full-time employee 6- 20 Employees: $375.00
2 Part-time employees= 1 Full-time employee 21- 50 Employees: $475.00
2 Part-time employees= 1 Full-time employee 51- 100 Employees: $595.00
2 Part-time employees= 1 Full-time employee Over 100 Employees: $700.00
2 Part-time employees= 1 Full-time employee Associate Member: $150.00
Retired Individuals, Clergy, elected officials & community members STUDENT RATE: $50.00
Must be full time in school. Middle, high school or college.

Additional Fees:

One-Time Processing Fee : $20.00
A single, non-refundable fee applied at the time of application to cover administrative and onboarding costs associated with setting up your membership.

Payment Option:

Charge my credit or debit card

Member Application

Mailing Address

Address

Address