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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


The Antioch Chamber would like to thank the following sponsors: