- Indian Valley Chamber of Commerce

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max): *

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words): *

Comments / Questions:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1:

Line 2:

City:

State:

Postal Code:

Country:

Social Networking:

LinkedIn Facebook

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Membership: 1-5 Employees: $205.00
Membership: 6-10 Employees: $242.00
Membership: 11-25 Employees: $295.00
Membership: 26 - 50 Employees: $365.00
Membership: 51-75 Employees: $425.00
Membership: 76-100 Employees: $475.00
Membership: 101-250 Employees: $550.00
Membership: 250+ Employees: $550.00
Each employee over 250 will be invoiced at .50 per employee.

Payment Option:

Bill me Charge my credit or debit card

Member Application

Mailing Address

Address

Address