Byrdstown Pickett County Chamber of Commerce 2015

Byrdstown Pickett County Chamber of Commerce
1005 Livingston Hwy · PO Box 447 · Byrdstown, TN 38549
www.dalehollow.com · dalehollow@twlakes.net
Office: (931) 864-7195
2015 MEMBERSHIP APPLICATION
STEP ONE: Membership Information
Company Name
Marketing Name (as you wish it to appear on print/web collateral)
Number of Employees
Street Address
Mailing Address
City
Company Phone
ST
Zip
Company Fax
Company Website
Company Email
Business Description
MAIN REPRESENTATIVE
Mr. Mrs. Ms. Dr. Other
Title
Email
Representative Phone
Representative Fax:
STEP TWO: additional information (if applicable )
Mailing address (if different from street address above)
City
ST
Zip
ST
Zip
Different Billing Contact
Different Billing Address
City
STEP THREE: total chamber investment
Please select one of the membership plans below:
Non Profit Organization
Private Membership ($10.00 add Spouse)
Home Based Business
Small Business
Accommodations
Marinas & Resort
Utility Cooperative
Bank
Manufacturing
Property Developer
Real Estate
Insurance
Medical Center
Hospital
$50
$50
$50
$100
$100
$1000
$1000
$1000
$500
$250
$250
$100
$500
$1000
STEP FOUR: areas of interest
Marketing/Advertising
Leadership Program
Economic Development
Conferences
Agri-Tourism
Grants
Small Business Workshops
Volunteer
STEP FIVE: Payment
Check Amount_________ Check No._________(payable to BPC Chamber)
For BPCC Use Only
Business Category:_________________________________________
Membership Development/Membership Kit _____________________________
Notes:__________________________________________________