Chamber of Commerce Membership Application

Please choose type of membership:

___ $50 per year for a general membership of one person or business
___ $25 per year for a second business
___ $10 per year for each additional business
___ $25 per year for an associate membership

Business Name                     ____________________________________________________

Your Name and Title             ____________________________________________________

Mailing Address                    ____________________________________________________

Street Address                      ____________________________________________________

Town                                       _______________________________ Zip _________________

Phone                                     ____________________________________________________

Fax                                          ___________________________________________________

Email                                       ___________________________________________________

Website                                  ___________________________________________________

Description of Business         ___________________________________________________

___________________________________________________________________________

__________________________________________________________________

Number of Employees          __________      Years in Business ___________

Total Annual Dues                __________       Check Enclosed  ___________

Referred by _____________________________________________________   

Please print and mail to:

Quilcene/Brinnon Chamber of Commerce
PO Box 774
Quilcene WA 9837