By submitting this form, we accept your invitation for membership into the Jennings County Chamber of Commerce. We understand that our investment supports our share of the costs of maintaining and developing business programs within the Chamber of Commerce.

NOTE:   Fields with asterisks ( * ) are required fields.

Business / Organization Name *   Owner of Business *   Contact Person & Title *

BUSINESS MAILING ADDRESS

Address 1 *   Address 2   City *   State *         Zip Code *

BILLING MAILING ADDRESS (If different than Business Mailing Address)

Address 1   Address 2   City   State            Zip Code             Phone Number *           Fax Number             Email Address *   Website   Date Business Established *          Principle Product or Service *                                 Check all Desired Methods of Communication Email Phone Fax US Postal Service

Do you wish to receive fax broadcasts from the Chamber? Yes No

CALCULATE   your Annual Dues or   VIEW   the Business Classifications, a guideline to figure your Annual Dues.   Annual Investment   (include $25.00 Administrative Fee for New Members)

How would you like to pay your annual investment?

Annual:   Dues payable by January 31, 2004 Semi-Annual:   Dues Payable by January 31, 2004 and July 1, 2004

Check all items for which you need more information or would like to support

Small Business Development Information SIHO Insurance Ribbon Cutting / Grand Opening Business After Hours / Host Newsletter Inserts / Advertising CertifiChecks Mailing Labels / Membership List Serving on a Chamber Committee / Chamber Board of Directors Rural Urban Dinner Sponsor Business Appreciation Luncheon / Door Prize Special Collection Days / Sponsor Annual Dinner Sponsorship / Civic Scholarship Sponsor Annual Golf Scramble Friday the 13th Fund Raiser / Sponsor / Golfer / Prize Civic Scholarship Sponsor Member-to-Member Discount Card

Additional Comments

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