Full Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Full Business Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Business Phone Number *

(###)

###

####

Fax Number

(###)

###

####

Date your business started *

MM

DD

YYYY

Main Contact Name *

First Name

Last Name

Main Contact Phone *

(###)

###

####

Secondary Contact Name

First Name

Last Name

Secondary Contact Phone

(###)

###

####

Investment Level (check one) *

For more information about the price and benefits of the various investment levels, please see chart on this page.

Individual (not a business) $100

Nonprofit Organization or Club $120

Associate $275

Partner $375

Executive $575

Investor $750

President's Circle $1500

Agreement *

I understand I am signing up for a one year partnership with the Delta Area Chamber of Commerce at the Investment Level stated above that will automatically renew annually unless I present in writing that I am cancelling. I agree that the Chamber can fax, call, email, or otherwise share information about my company and activities in any matter as needed.

Yes, I understand