Membership Application

Business Information

Business Name:

Rep. Name:

Address:

City:

Zip

Mailing Address:

City:

Zip:

Phone:

Extension:

Fax:

E-Mail:

Website:

Number of Employees:

Type of Business:

Investment $:

Processing Fee: $25

Total Investment:

**The Antioch Chamber does not sell or give out email addresses or fax numbers unless a signed statement is on file. The Chamber has my permission to publish or distribute my email and/or my fax number.

Your Interests:

Hold a Board Position

Hold a Committee Chair Position

Economic Development

Golf Tournament/Trade Show

Women's Conference

Membership Development/Ambassadors

Business Netowrking

Publicity/Marketing Opportunities

Office Assistance

Host a Business After Five Mixer

I am joining the Antioch Chamber of Commerce because:

If I am confirmed for membership with the Antioch Chamber of Commerce, I agree to support the mission and the vision of the chamber.

I agree