Member

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max):

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words):

Comments / Questions:

Source - How did you hear about us?:

Join Committee: Ambassadors:

Join Committee: Events:

Join Committee: Marketing & Tourism:

Join Committee: Transportation:

Join Committee: GOOD NEIGHBOR DAYS (many chair positions available):

Request Benefit: Ribbon Cutting:

Request Benefit: Membership Referral:

Request Benefit: Receive Chamber Communication:

Request Benefit: Be a Business Spotlight:

Request Benefit: Welcome to Washington packets:

Request Benefit: Member to Member Offers:

Request Benefit: Advertising Opportunities:

Request Benefit: Sponsorship Opportunities :

Request Benefit: Host a Business After Hours:

Request Benefit: Be a Leader in the Chamber:

Request Benefit: Bulk Mail Permit:

Request Benefit: Info displayed in Chamber office:

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

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook

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: *

Title:

Phone: *

Cell Phone:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Stakeholder - New Member: $6,000.00
Aspire - New Member: $3,000.00
Growth - New Member: $1,500.00
Main Street - New Member: $750.00
Business - New Member: $300.00
Basic Membership:

Payment Option:

Charge my credit or debit card

Member Application

Mailing Address

Address

Address