LONG COUNTY CHAMBER OF COMMERCE by 5w283y

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									                       LONG COUNTY CHAMBER OF COMMERCE
                            MEMBERSHIP APPLICATION
                                    CHAMBER YEAR 2012-2013 *


Business Name: _________________________________________________________
(If a couple or individual, list your name(s) above)

Contact Person: _________________________________________________________

Mailing Address: ________________________________________________________

Physical Address: _______________________________________________________

City: ______________________________ State: _____         Zip: ________________

Phone: __________________________________         Fax: _______________________

Email: _________________________________________________________________

Business Website: _______________________________________________________

Type of Business: ____________________________________ # of Employees: _______


Annual Dues:
       Business            $50.00
       Couple              $40.00
       Individual          $25.00


Make checks payable to:
       LONG COUNTY CHAMBER OF COMMERCE

Mail application to:
       LONG COUNTY CHAMBER OF COMMERCE
       ATTN: Mrs. Claudine Chesser, Membership Chairperson
       PO Box 400
       Ludowici, GA 31316


Please indicate your preference regarding your information to be listed on the Chamber’s website.

Phone number: List______      Do not list_____

Email address:   List ______ Do not list_____

                       (* The Chamber Year runs from 1 July through 30 June)

								
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