MEMBERSHIP APPLICATION

                                                                                PRINT OR TYPE                                                                               

NAME OF BUSINESS:__________________________________________________________________________     

OWNER NAME:           __________________________________________________________________________  

PHYSICAL ADDRESS: _________________________________________________________________________   
911 address

   City, State, Zip              _________________________________________________________________________

VOTING DELEGATE: _________________________________________________________________________    
Only one voting delegate per business/ one vote only per business

MAILING ADDRESS:   _________________________________________________________________________   
Voting delegates

  PO Box/ street              __________________________________________________________________________

  City, State, Zip             __________________________________________________________________________

PHONE NUMBERS:    _______________________________ FAX ______________________________________    

  Categories (Circle choices) Accommodations—Dinning—Shopping—Services—Entertainment

With this signature, I am designating the above person as the sole-voting representative of the above mention business.  I am remitting my company check or cash of $100.00 as my dues for membership in THE GREATER HELEN AREA CHAMBER OF COMMERCE for the 2008-2009 year. (August 1, 2008 - July 31, 2009)

  Master Card/Visa # ________________________________Expiration Date__________

  _____________________________________________________________________________________________
SIGNATURE OF BUSINESS OWNER or MANAGER

  Print Name:                ______________________________________________________________________________

  Date:      ______________________________________________________________________________________

  WEBSITE INFORMATION:

The following information is what will be posted on the Chamber’s web site.  Please print very clearly as one missed letter on your email or web site name will keep people from finding you on the Internet. Fill in only what you wish to appear on the web site.

  Web site information:  Print Clearly

  Name of Business:            _____________________________________________________

  Physical Address:            ______________________________________________________

 “911 Address”                  ______________________________________________________

  City, State, Zip:            ______________________________________________________

  Category under which you wish to be listed:  (circle as many that applies ) 

 Accommodations, Shopping, Services, Dining, Entertainment

 Phone number:            „„„-„„„-„„„„ ext.„„„„

Fax number:                 „„„-„„„-„„„„

Toll Free Number            „„„-„„„-„„„„

  Email Address: print clearly

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  Web site Address:

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