Member Application

Kosciusko Chamber of Commerce

We are excited that you will be partnering with your Kosciusko Chamber of Commerce. We look forward to working together with you to promote your organization and continuing to build a strong community. Upon the completion of this application, your organization will be charged a one time application fee of $25 in addition to your annual membership dues.

Step 1: Member Info

Step 2: Additional Info

Step 3: Primary Contact

Step 4: Billing Contact

Step 5: Membership Options

Step 1:

Member Info

Company Name *

Please add your company name.

Phone *

Please add your company phone number.

Website

Email *

Please add a valid email.

Physical Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Mailing Address

Same as physical address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Step 2:

Additional Info

Business Description (200 char max) *

Please add your company description.

Directory Category *

Please select a directory category.

Full-time Employees *

Please add your number of full-time employees.

Part-time Employees *

Please add your number of part-time employees.

Step 3:

Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Phone *

Please add your phone number.

Email *

Please add a valid email.

Contact Preference

Phone

Step 4:

Billing Contact

Same as Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Phone *

Please add your phone number.

Email *

Please add a valid email.

Contact Preference

Phone

Step 5:

Additional Fees:

Membership Application Fee $25 one time

Membership Application Fee

Comments/Questions

Payment Option

Bill Me

Please complete the Captcha

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Member Application

Kosciusko Chamber of Commerce

Step 1:

Member Info

Physical Address

Mailing Address

Step 2:

Additional Info

Step 3:

Primary Contact

Step 4:

Billing Contact

Step 5:

Additional Fees:

Payment Option

Contact Info

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