Member - – The Greater Mount Airy Chamber of Commerce

Business Information

Company Name: *

Leave Blank:

Phone: *

Website: *

Email: *

Business Description (200 char max): *

Directory Category: *

Employees: *

Full-time Part-time

Comments / Questions:

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

Primary Contact Information

First Name: *

Last Name: *

Phone: *

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

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: *

Phone: *

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Membership Package: *

Membership Package 1: $260.00
1-5 Full-Time Employees Membership Package 2: $280.00
6-11 Full-Time Employees Membership Package 3: $385.00
11-25 Full-Time Employees Membership Package 4: $505.00
26-50 Full-Time Employees Membership Package 5: $650.00
51-100 Full-Time Employees Membership Package 6: $775.00
101-250 Full-Time Employees Membership Package 7: $1,060.00
251-500 Full-Time Employees Membership Package 8: $1,240.00
501-1000 Full-Time Employees Membership Package 9: $1,400.00
1000+ Full-Time Employees

Payment Option:

Charge my credit or debit card

Member Application

Mailing Address

Address

Address