CM Member App Template - Brunswick-Golden Isles Chamber of Commerce

Business Information

Company Name: *

Phone: *

Website:

Email:

Physical Address

Line 1: *

Line 2:

City: *

State / Province: *

ZIP / Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1:

Line 2:

City:

State / Province:

ZIP / Postal Code:

Country:

Primary Contact Information

First Name: *

Last Name: *

Phone: *

Email: *

Contact Preference:

Email Phone

Address

Same as Company Address

Line 1:

Line 2

City:

State / Province:

Zip / Postal Code:

Country:

Membership Options

Additional Fees:

New Member Administration Fee
A $20 fee is charged to all new members for Administrative Costs to the Chamber.

Additional Opportunities:

We will contact you with additional information.

Leads List
$100/year. Receive a monthly listing of contacts who've relocated to the area or who've requested a relocation package. Member Labels
Ready-to-use mailing labels of our entire chamber membership for $150.

Payment Option:

Charge my credit card

In the effort to fight spam, please provide the answer to the following question.

What is the sum of 5 plus 7?: *

Member Application

Physical Address

Mailing Address

Address