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Name of Business or Organization: (required)*

Primary Contact Name: (required)*

Phone Number: (required)*

Fax:

Address: (required)*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email Address: (required)*

Website:

Twitter:

Facebook:

LinkedIn:

Business Category (type):*

If your business type is not featured on this list, please select "other" and fill in the field below.

Other:

If you would like additional categories associated with your business, please contact the Chamber Office directly.

Name of Chamber Membership Sponsor (Not required):

Membership Application Fees*

* $35 one-time application fee plus the following

Tag Line for Membership Directory and Web Site ($35) (Maximum 150 Characters)

(this will appear under the business name)

Invoice

I would like to receive an emailed invoice.

Membership Statement

The information on this application is, to the best of my knowledge, accurate and complete. My organization, and all of its representatives, will abide by the Membership Code of Conduct, and by-laws of the Phoenixville Regional Chamber of Commerce and understand that membership in the Chamber is annual. The paying organization will hold the membership and may change its designated representative at will. If my membership is terminated, any use of the Chamber's name or reference to the Chamber shall be immediately discontinued. Once paid, membership is non-refundable. Information on this application may be used for Chamber press releases and other publications.

By submitting this application, you agree to the terms outlined above.