CHAMBER OF COMMERCE MEMBERSHIP APPLICATION

Please fill in the fields below and click Submit.
Name:		Business Phone:
Business Name:
Address:
City:		State:	Zip:
E-Mail:		Twitter:
Website:		Facebook:
LinkedIn:
I will Allow Disallow the chamber to distribute my contact information.
How did you hear about us? Referral Online/Website Other
Referred by a Chamber member? Please list them here (list only one):
Name:
I would like to participate in the Farmingville FUNds Card program: Yes No
I can offer a 15% (Top Listing) 10% 5% discount to members/residents holding a valid Farmingville FUNds Card.
Our philosophy is that a strong community comprises of businesses, nonprofit organizations and residents. Therefore, the Chamber membership is open to all three. Business Membership - $100.00 • A business listing on FarmingvilleChamber.com • Opportunity to sponsor community events • Various brand promotions throughout the community Nonprofit - $75.00 (501(c) is required) - Same benefits as the Business Membership Residential Member - $50.00 - Personal / Residential listing only
I would like to apply for Business Membership ($100) Nonprofit Membership ($75) Resident Membership ($50) to the Farmingville Hills Chamber of Commerce, Inc.
Please let us know why you are joining the Chamber and/or what we can do to help.
	Enter your response here
By clicking "Submit" below, you are agreeing to faithfully uphold the By-laws of the Farmingville Hills Chamber of Commerce, Inc.

Thank you for making a difference