Application for Membership

4211 Trindle Road, Camp Hill, Pennsylvania 17011 (717) 761-0702 Fax (717) 761-4315

Member Application

You can print this form to fill it out and mail it to the Chamber or fill it in online.
Click "submit" at the bottom of the page and the Chamber will receive it via email.
* Indicates Required Data

Date:
First Name:	*
Last Name:	*
Phone:	*
Title:
Company:
Address (city,state,zip):
Billing Address:
Referred by:

Number of Employees at Membership Location Including Owner

Full Time:

Part Time:

Membership is based on the number of full-time employees.

Annual membership includes one primary representative.

Additional primary representatives receive full membership

benefits.

A one-time processing fee of $25 will be applied to new members.

This fee applies to all categories. Applicants are approved by the

Board of Directors at their monthly meetings, after which you will

receive a plaque and door decal to promote your membership to

the community.

The following Dues Structure will go into effect May 1, 2010

Membership Investment
Employees	Amount
Retired	$120
1-4	$300
5-9	$360
10-20	$400
21-100	$400 + $5 for each employee over 20 includes 1 additional primary representative at the same location
101-500	$800 + $.50 for each employee over 100 includes 2 additional primary representatives at the same location
501+	$1,000 + $.10 for each employee over 500 includes 3 additional primary representatives at the same location

Education & Municipalities
Employees	Amount
1-4	$300
5-9	$360
10-50	$400
51-100	$460
101-200	$500
201-300	$560
301-500	$600
501+	$700

Non-Profit*
Employees	Amount
1-4	$300
5-9	$360
10-20	$400
21+	$400 + $5 per employee over 20 max $460
*Organizations or agencies recognized by the Internal Revenue Service as 501c organizations or religious organizations that rely on contributions and grants, rather than dues, fees or retail sales, as its primary source of revenue.

E-mail the Chamber for More Information

Business Referral Information

Business Establish Date:

Business Category (Chamber Category May Vary):

Business Description (20 words or less for Online Directory listing):

Web Site address:

Your Email: *

Please enter the characters in the image below:

Upon receipt the Membership Director will call or email you to complete your membership! Thank you and congratulations on this wise business investment!

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