Executive Circle Membership

Advisory Board Member

Scheduled use of Chamber board room

for Member Benifits

Business Name________________________________________

Representative Name___________________________________

Title_________________________________________________

                              Business Address______________________________________

                               City/State/Zip__________________________________________

Mailing Address if different________________________________

Business Phone_______________ Fax Number_____________

E-mail address________________________________________

Website_____________________________________________

Number of Employees__________________________________

Nature of Business_____________________________________

Annual  Investment Executive Circle Member 1-2 Full Time Employees……?.338.00 3-10 Full Time Employees……?20.00 11-25 Full Time Employees……..680.00 26-100 Full Time Employees……860.00 Over 100 Full Time Employees...1198.00 Please count 2 part-time employees as one full-time employee