To the Board of Directors,

I, the undersigned, hereby wish to join the Banks County Chamber of Commerce with a ________________________ (type) membership, thereby endorsing the business ethics for which it stands. This is membership for one year with the annual renewal date due one year from the original date of membership.

Membership Name: ________________________________

Mailing Address:___________________________________

Business Phone: ___________________________________

Fax Phone: _______________________________________

Alternate Phone: ___________________________________

E-Mail Address: ___________________________________

Website: _________________________________________

Signature: ________________________________

Date: _________________________ Print Name: _______________________________________________________

For Chamber Use Only
Obtained by: ___________________________________________________
Amount Paid: __________________ Check # ___________ Date Received ___________
Type of Business: Other:
$150 Agri-business __________ $100 Individual/Family __________
$100  Church __________ $50 Senior Citizen (65+) __________
$100 Civic Org. __________ $25 Student (under 22) __________
$200 Restaurant/Hotel __________ $50 Farms __________
$800 Utility __________
$250 Professional __________
$500 Financial __________
$250 Education __________ $50 Departments __________
$250 Government/Municipalities __________ $50 Departments __________
General Business Amount Number of Employees Amount
1-4 $100 25-50 $200
5-8 $125 50- over $250
8-25 $150