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Membership Application

Membership Categories and Dues: Please indicate appropriate level.

  • Individual ($60)
  • Corporate ($100, up to 4 individuals)
  • Corporate Sponsor ($150)

Name

First

 

Last

 

Company

 

 

Department

 

 

Address

 

 

City

 

 

State

 

 

Phone

 

 

Fax

 

 

E-mail

 

 

Referred by

 

 

 

 

CORPORATE MEMBERS

 

 

1. (Main  Contact)

 

 

2.

 

 

3

 

 

4.

 

 

 

Renewal membership dues are billed annually and are valid from September 1 through August 31

Payment must accompany this form

Please mail or e-mail this form to the address above:

Or contact

Jennifer Bonk
Greater Beloit Chamber of Commerce
500 Public Ave.
Beloit, WI 53511
(608) 365-8835
www.greaterbeloitchamber.com
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