Member - Independence Chamber of Commerce

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

Directory Category *

Please select a directory category.

Who referred you?

How many years have you been in business? *

Looks good!

Step 3:

Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title

Phone *

Please add your phone number.

Cell Phone

Email *

Please add a valid email.

Contact Preference

Phone

Address

Same as Address in Step 1

Address line 1

Address line 2

Country

City

State

Postal Code

Step 4:

Billing Contact

Same as Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title

Phone *

Please add your phone number.

Cell Phone

Email *

Please add a valid email.

Contact Preference

Phone

Address

Address line 1

Address line 2

Country

City

State

Postal Code

Step 5:

Membership Package

Please select a Membership Package

Community Leader $7,550

Visionary $3,840

Influencer $1,450

Champion $595

Partner $365

Starter $150

Been in business less than 3 years. Maximum 2 years at this level. 5 or less employees.

Payment Option

Bill Me

Charge my credit or debit card

Please complete the Captcha

Back Next Submit Application Print Application

Member Application

Step 1:

Member Info

Physical Address

Mailing Address

Step 2:

Additional Info

Step 3:

Primary Contact

Address

Step 4:

Billing Contact

Address

Step 5:

Membership Package

Payment Option